L_Lisfranc_Midfoot_Inj.pptVIP

Fractures and Dislocations of the Mid-foot Including Lisfranc Injuries Arthur K. Walling, MD Clinical Professor of Orthopaedics Director Foot and Ankle Fellowship Florida Orthopaedic Institute, Tampa, Florida Created March 2004; Revised August 2006 Lisfranc’s Joint Injuries Any bony or ligamentous injury involving the tarsometatarsal joint complex Named after the Napoleonic-era surgeon who described amputations at this level without ever defining a specific injury Anatomy Lisfranc’s joint: articulation between the 3 cuneifoms and cuboid (tarsus) and the bases of the 5 metatarsals Osseous stability is provided by the Roman arch of the metatarsals and the recessed keystone of the second metatarsal base Anatomy Lisfranc’s ligament: large oblique ligament that extends from the plantar aspect of the medial cuneiform to the base of the second metatarsal (there is no transverse metatarsal ligament from 1 to 2) Anatomy Interosseous ligaments: connect the 2 thru 5 metatarsal bases both dorsal and plantar (stronger and larger) Secondary stabilizers: plantar fascia, peroneus longus, and intrinsincs Anatomy Four Major Units 1. 1st MT – Medial Cuneiform: 6 degrees of Mobility 2. 2nd MT – Middle Cuneiform Firmly Fixed 3. 3rd MT – Lateral Cuneiform Firmly Fixed 4. 4th – 5th MT – Cuboid: Mobile Anatomy Associated Structures: 1. Dorsalis pedis artery – courses between 1st and 2nd metatarsal bases 2. Deep peroneal nerve: runs alongside the artery Incidence Generally considered rare ( 1 per 55,000 people per year or 15/5500 fractures ) As index of suspicion increases, so does incidence Approximately 20% of Lisfranc’s injuries may be overlooked ( especially in polytraumatized patients ) Mechanisms of Injury Trauma: motor vehicle accidents account for one third to two thirds of all cases (incidence of lower extremity foot trauma has increased with the use of air bags) Crush injuries Sports-related injuries are also occurring with increasing frequency Mechanisms of Inju