Lisfranc injury

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Lisfranc injury , also known as Lisfranc fracture , is a foot injury in which one or more metatarsal bones are displaced from the tarsus. This injury was named Jacques Lisfranc de St Martin (April 2, 1790-13 May 1847), a French surgeon and gynecologist who described the amputation of the foot through tarsometatarsal articulation, in 1815, after the Sixth Coalition War.

Video Lisfranc injury

Cause

In humans, the midfoot consists of five bones that form the arch of the foot (cuboid, navicular, and three cuneiform bones) and their articulation on the basis of five metatarsal bones. Lisfranc injuries are caused when excessive kinetic energy is applied either directly or indirectly to the midfoot and is often seen in a traffic collision or industrial crash.

A direct Lisfranc injury is usually caused by a devastating injury, such as a heavy object falling into the middle leg, or the foot being hit by a car or truck, or someone who lands on foot after falling from a significant height. Lisfranc indirect injury is caused by a sudden rotational force on the plantar's flexed back (pointing down). Examples of this type of trauma include a rider who falls from a horse but the remaining leg is trapped in the stirrups, or someone falls forward after stepping into a storm channel.

In athletic trauma, Lisfranc injuries occur generally in activities such as windsurfing, kite surfing, wakeboarding, or snowboarding (where the bindings tool passes directly above the metatarsal). American soccer players sometimes get this injury, and it most often happens when the athlete's legs are flexed plantar and other players land on the heels. This can also be seen in a rotating athletic position such as a baseball catcher or ballerina spinning.

Maps Lisfranc injury

Diagnosis

In high-energy injuries to the middle leg, such as falling from a height or motor vehicle accident, a diagnosis of Lisfranc injury should, at least in theory, be less challenging. There will be midfoot deformities and X-ray deformities must be clear. Further, the nature of the injury will create a high clinical suspicion and may even have a disruption to the skin above it and the compromise of the blood supply. A typical X-ray find will include a gap between the base of the first and second toes. Diagnosis becomes more challenging in the case of low energy incidents, as is possible with tortuous injuries in the racquetball field, or when the American Football midfielder is forced back into the already fully plantar flexed leg. Then, there may be only complaints of an inability to bear weight and some mild swelling of the forelegs or middle legs. Bruised arches have been described as diagnostic under these circumstances but may not exist. Typically, conventional radiography of the foot is used with a non-weight standard view, which is equipped with a weighted view that may indicate the widening interval between the first and second toes, if the initial view fails to show abnormality. Unfortunately, radiography in such circumstances has a 50% sensitivity when the bearings are non-heavy and 85% load-bearing, meaning that they will appear normal in 15% of cases where Lisfranc injury actually exists. In the case of seemingly normal x-rays, if clinical suspicion persists, advanced imaging such as magnetic resonance imaging (MRI) or X-ray computed tomography (CT) is the next logical step.

Classification

There are three classifications for fracture:

1. Homolateral: The five metatarsals flee in the same direction. Lateral displacement may also exhibit cuboid fractures.
2. Isolated: one or two metatarsal displaced from another.
3. Different: metatarsals displaced in the sagittal or coronal plane and may also involve the intercuneiform area and include navicular fractures.

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Treatment

Options include operative or non-operative treatment. If the dislocation is less than 2 mm, the fracture can be managed by casting for six weeks. The injured member of the patient can not bear the weight during this period. For severe Lisfranc injury, open reduction with internal fixation (ORIF) and temporary screw or Kirschner wire fixation (K-wire) is the treatment of choice. The legs can not be left weight for at least six weeks. Partial logging can begin, with full load bearing after an additional few weeks, depending on the specific injury. K-wires are usually removed after six weeks, before holding the load, while screws are often removed after 12 weeks.

When the Lisfranc injury is characterized by significant displacement of the tarsometatarsal joint (s), nonoperative treatment often leads to severe loss of function and long-term disability secondary to chronic pain and occasionally to planovalgus deformity. In cases of severe pain, loss of function, or progressive deformity that has failed to respond to nonoperative treatment, tarsal and tarsalumalarsal arthrodesis (bone fusion surgery) may be indicated.

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History

During the Napoleonic Wars, Jacques Lisfranc de St Martin met a soldier who suffered vascular compromises and secondary gangrene on the leg after falling from a horse. Furthermore, Lisfranc performs amputations at the tarsometatarsal joint level, and that the leg area has since been eponymously referred to as the "Lisfranc joint". Although Lisfranc does not explain the specific mechanisms of injury or classification schemes, Lisfranc injury means a dislocation or fracture-dislocation injury in the tarsometatarsal joint.

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See also

• Bosworth Fracture
• Dislocation fracture-Chopart
• Jones fracture
• Lisfranc ligament
• List of eponymous fractures
• Fraktur Maret

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References

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External links

• Diagnosis of the joint

Source of the article : Wikipedia