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Lisfranc injury

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Lisfranc injury

The Lisfranc injury (also known as the Lisfranc fracture, Lisfranc dislocation, Lisfranc fracture dislocation, tarsometatarsal injury, or simply midfoot injury) is an injury of the foot in which one or all of the metatarsal bones are displaced from the tarsus.[1][2] This type of injury is named after Jacques Lisfranc de St. Martin (2 April 1790–13 May 1847), the French surgeon and gynecologist who first described the injury in 1815, after the War of the Sixth Coalition.[3]

Causes

In humans, the midfoot consists of the five bones that form the arches of the foot (the cuboid, navicular, and three cuneiform bones) and their articulations with the bases of the five metatarsal bones. Lisfranc injuries are caused when excessive kinetic energy is applied either directly or indirectly to the midfoot. These injuries are often seen in the setting of traffic collisions or industrial accidents.[4]

Direct Lisfranc injuries are usually caused by a crush injury, such as when a heavy object falls onto the midfoot, or when the foot is run over by a car or truck, or when someone lands on the foot after a fall from a significant height.[5] Indirect Lisfranc injuries are caused by a sudden rotational force on a plantar flexed (downward pointing) forefoot.[4] Examples of this type of trauma include when a rider falls off his horse but his foot remains trapped in the stirrup, or when a person falls forward after accidentally stepping into a storm drain.[5]

In the setting of athletic trauma, Lisfranc injuries occur commonly in activities such as windsurfing, kitesurfing or snowboarding (where participants' feet are in bindings that pass over the metatarsals). American football players occasionally acquire this injury, such as Matt Schaub[6], Darren McFadden[7] and Santonio Holmes. 

New York Jets general manager Mike Tannenbaum announced on Wednesday Oct 3, 2012, Receiver Santonio Holmes has been placed on season-ending injured reserve. The  Super Bowl XLIII Most Valuable Player sustained a Lisfranc injury to his left foot at the start of the fourth quarter in Sunday's 34-0 loss to the San Francisco 49ers on september 26, 2012. Signed to a five-year, $45 million contract, Holmes caught 51 passes for 654 yards and eight touchdowns in '11 but was benched during the second half of the Jets' regular-season finale as teammates claimed he quit on the club. The injury often occurs when an athlete has their foot plantar flexed and another player lands on their heel.

Classification

There are three classifications for the fracture:[8]

  1. Homolateral: All five metatarsals are displaced in the same direction. Lateral displacement may also suggest cuboidal fracture.
  2. Isolated: one or two metatarsals are displaced from the others
  3. Divergent: metatarsals are displaced in a sagittal or coronal plane. May also involve intercuneiform area and a navicular fracture.

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.[citation needed] The patient's injured limb cannot bear weight during this period. For severe Lisfranc injuries, open reduction with internal fixation (ORIF) and temporary screw or Kirschner wire (K-wire) fixation is the treatment of choice.[9] The foot cannot be allowed to bear weight for a minimum of 6 weeks. Partial weight-bearing may then begin, with full weight-bearing after an additional several weeks, depending on the specific injury. K-wires are typically removed after 6 weeks, before weight-bearing, while screws are often removed after 12 weeks.[9]

In people with Lisfranc injuries 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 sometimes to a planovalgus deformity. In cases where there is severe pain, loss of function, or progressive deformity that has failed to respond to nonoperative treatment, mid-tarsal and tarsometatarsal arthrodesis (operative fusion of the bones) may be indicated.[10]

History

During the Napoleonic Wars, Jacques Lisfranc de St. Martin encountered a soldier who suffered from vascular compromise and secondary gangrene of the foot after a fall from a horse.[3] Subsequently, Lisfranc performed an amputation at the level of the tarsometatarsal joints,[3] and that area of the foot has since been eponymously referred to as the "Lisfranc joint".[11] Although Lisfranc did not describe a specific mechanism of injury or classification scheme, a Lisfranc injury has come to mean a dislocation or fracture-dislocation injury at the tarsometatarsal joints.[12]

See also

References

  1. ^ Lisfranc's fracture at Who Named It?
  2. ^ "Lisfranc's fracture". The Free Dictionary.
  3. ^ a b c Lisfranc, J (1815). Nouvelle méthode opératoire pour l'amputation partielle du pied dans son articulation tarso-métatarsienne: méthode précédée des nombreuses modifications qu'a subies celle de Chopart (in French). Paris: L’imprimerie de Feuguery. pp. 1–52.
  4. ^ a b Smith BR, Begeman PC, Leland R, Meehan R, Levine RS, Yang KH, King AI (2005). "A Mechanism of Injury to the Forefoot in Car Crashes". Traffic Injury Prevention. 6 (2): 156–69. doi:10.1080/15389580590931635. ISSN 1538-9588. PMID 16019401.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ^ a b Chan, SCF; Chow, SP (2001). "Current concept review on Lisfranc injuries" (PDF). Hong Kong Journal of Orthopaedic Surgery. 5 (1): 75–80.
  6. ^ "Texans Place Matt Schaub on IR (available to GlobePlus members only)". The Globe and Mail. Toronto: The Globe and Mail Inc.
  7. ^ Tafur V (2011-12-12). "Hue Jackson says McFadden isn't out for season". San Francisco Chronicle online. San Francisco: Hearst Corporation. Retrieved 2012-06-05. Phil Simms said on the CBS telecast of the game that injured Oakland running back Darren McFadden, and Kelly Anderson has a Lisfranc injury to his right foot, and not a mid-foot sprain, and could be out for the year.
  8. ^ Wheeless CR (2011). "Lisfranc's Fracture / TarsoMetatarsal Injuries". Wheeless' Textbook of Orthopaedics online. Durham, North Carolina: Duke Orthopaedics. Retrieved 2012-06-05.
  9. ^ a b Mulier, T; Reynders, P; Sioen, W; Van Den Bergh, J; De Reymaeker, G; Reynaert, P; Broos, P (1997). "The Treatment of Lisfranc Injuries" (PDF). Acta Orthopaedica Belgica. 63 (2): 82–90. ISSN 0001-6462. PMID 9265792.
  10. ^ Mann, RA; Prieskorn, D; Sobel, M (1996). "Mid-tarsal and tarsometatarsal arthrodesis for primary degenerative osteoarthrosis or osteoarthrosis after trauma". Journal of Bone and Joint Surgery, American Volume. 78 (9): 1376–85. PMID 8816654.
  11. ^ Lisfranc's joint at Who Named It?
  12. ^ DiDomenico, LA; Cross, D (2012). "Tarsometatarsal/Lisfranc Joint" (PDF). Clinics in Podiatric Medicine and Surgery. 29 (2): 221–42. doi:10.1016/j.cpm.2012.01.003. PMID 22424486.
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