Lisfranc fracture
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| Lisfranc fracture | |
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| Lisfranc fracture demarcated by the oval with distal 2nd to 4th metatarsal fractures marked by the arrow. | |
| eMedicine | orthoped/511 |
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.
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[edit] History
This injury is mistakenly attributed to being first described by French doctor and surgeon Jacques Lisfranc de St. Martin, a field surgeon in Napoleon's army, serving on the Russian front. He actually described a method of forefoot amputation without osteotomy across the tarsometatarsal joints, for management of gangrene. This then became known as the Lisfranc joint and associated Lisfranc ligament.[citation needed]
[edit] Causes
This type of injury classically 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, Indianapolis Colts defensive end Dwight Freeney, whose injury on November 11, 2007 ended his season. and Buffalo Bills defensive end Aaron Schobel, whose injury in early 2008 ultimately led to his placement on IR, ending his season. More recently, the world famous soccer player Kaká, mid-offence of A.C. Milan, is currently recovering from an injury that he suffered in 2009. There are also other ways of receiving such an injury.
[edit] Classification
There are three classifications for the fracture:
- Homolateral: All 5 metatarsals are displaced in the same direction. Lateral displacement may also suggest cuboidal fracture
- Isolated: 1 or 2 metatarsals are displaced from the others
- Divergent: metatarsals are displaced in a sagittal or coronal plane. May also involve intercuneiform area and a navicular fracture.
[edit] Treatment
Treatment options include operative or non-operative treatment. If the dislocation is less than 2 mm, the fracture can be managed with casting 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.
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