Abstract
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Diagnosis
a. History and exam
i. True Lisfranc fracture dislocations are NOT difficult to diagnose
b. Midfoot sprains or subtle injuries
i. These are DIFFICULT to diagnose
- subtle x-ray findings with minimal displacement
i) Exam: - be “suspicious” of midfoot sprains
- TMT tenderness, swelling
- inability to WB
ii) Mechanism of injury:
- indirect twisting injury (athletic)
- crush injury of the foot (trauma)
- axial forefoot loading (dancers, jumpers)
iii) Investigations:
- X-rays usually normal or subtle widening
need to assess all 3 views in detail
standing AP compare to the other side
-Stress x-rays: - if clinical symptoms indicate - severe injury + pain but x-ray looks normal
- MRI useful for anatomic/instability correlation
- CT scan good for subtle injuries/fractures and displacement
- Bone scan positive in subacute/chronic pain situation
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Treatment
a) Surgical Indications
i) Any displacement/positive stress xrays/test
ii) Surgical technique
- open reduction or closed and percutaneus fixation
- anatomic reduction essential
- NWB period up to 6 weeks
- WB with protection for another 4-6 weeks
iii. Screw vs tightrope fixation
iv. Hardware removal
b) Non-operative
i) Stable non-displaced sprain (need to make sure this is stable, ie stress views)
- 6 to 8 weeks NWB
- expect prolonged recovery up to 6 months with
proper treatment
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Controversial Issues:
a. Do all injuries with mild displacement have to be fixed operatively?
b. Arthrodesis vs fixation for soft tissue lisfranc with mild displacement?
c. Arthrodesis vs fixation subacute or chronic presentation?
d. Hardware removal?
