Lisfranc Joint Injuries

 Lisfranc Joint consists of three cuneiform and two cuboid metatarsal articulations. 

 Stability- strong ligament and recessing of second metatarsal head. 

                 Lisfranc ligament - base of 2nd metatarsal to medial cuneiforms. 

How to proceed to this type of injuries ?

    Always a trauma case management quires ATLS approach,

  Analgesia

  Elevation

  Resting/ Splinting

  Rule out Compartment Syndrome

   Radiographs - AP  / Oblique 

    If needed CT 

    wait swelling to subside (skin softening , wrinkles )

What we see on X-ray ?

    AP view - 2nd MT and medial cuneiform medial borders align

    Oblique - medial border of 4th MT and cuboid align.

                    fleck sign - avulsion of Lisfranc ligament. 

https://www.orthointerview.com/News/post/?permalink=core-knowledge-lisfranc-injury

Classification of Lisfranc Injuries

    Type A - Unipolar dislocation involving whole joint

            B -  Partial dislocation -medial or lateral

            C - Divergent 

https://drhem.wordpress.com/tag/trauma/page/2/

How to manage such cases ?

        Open or Closed Reduction 

         Screws / K-wire Fixation

          start with 2nd MT reduction

    two skin incision

        one over 1st web space

        2nd over 4th MT 

Chances of post-traumatic Osteoarthritis is 30 % in long term.