Lisfranc fracture

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Lisfranc fracture
eMedicine orthoped/511 


Overview

The Lisfranc fracture is a fracture and dislocation of the joints in the midfoot, where a cluster of small bones forms an arch on top of the foot between the ankle and the toes. From this cluster, five long bones, the metatarsals, extend until the toes.

History

The fracture was first described by the French doctor and surgeon Jacques Lisfranc de St. Martin, who worked in Napoleon's army.

Causes

This type of injury, which Lisfranc first described, occurred when a horseman fell while riding, having trapped his foot in the stirrup or fell into a drain. At present, such an injury happens typically when one steps into a hole and the foot twists heavily. Falling from a height of two or three stories can also cause this fracture. American football players occasionally get this injury, often when they have their foot pointing down and someone lands on their heel. Examples include New England Patriots defensive back Ty Law, who suffered this injury in October, 2004, and Indianapolis Colts defensive end Dwight Freeney, whose injury on November 11, 2007 ended his season. There are also other ways of receiving such an injury.

X-ray

  • Fracture-dislocation or fracture-subluxation of the tarsometatarsal joints
  • Homolateral: Lateral dislocation of the 1st through 5th or 2nd through 5th metatarsals.
  • Divergent: Medial dislocation of the 1st metatarsal and lateral dislocation of the 2nd through 5th metatarsals

Treatment

Treatment options include operative or non-operative treatment. If the dislocation is less than 2mm, the fracture can be managed with a POP(plaster of Paris) or dynacast for 6 weeks. The patient's injured limb cannot bear weight during this period. For operative treatment, percutaneous screws +/- k-wire will be used for internal fixation of the fracture. Again, the patient's injured limb cannot bear weight. The screws/k-wires must be removed before weight bearing.

See also