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Lisfranc Injuries

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Orthopedic Surgery Clerkship

Abstract

The Lisfranc joint complex, consisting of the tarsometatarsal (TMT) articulations, is prone to injury with ligamentous and/or osseous disruption. The Lisfranc ligament, a strong interosseous ligament between the medial cuneiform and second metatarsal provides critical stability for the midfoot arch and allows for forefoot motion. Frequently observed after direct trauma to the foot or a low-energy twisting mechanism through a plantar-flexed forefoot, injuries may range from Lisfranc ligament sprain to fracture dislocations through all TMT joints. Patients often present with severe pain and inability to bear weight after precipitating trauma. Radiographic studies will reveal gapping between the first and second metatarsals at the TMT joint or a “fleck sign.” Treatment is based on stability of the midfoot. Totally stable patients or poor surgical candidates may be immobilized for 6–8 weeks. Unstable Lisfranc injuries necessitate surgery, with rigid screw fixation for the 1–3 TMT joints and Kirschner wires accepted for the fourth and fifth TMT joints. Primary arthrodesis of 1–3 TMT joints is an alternative option for isolated ligamentous injury.

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Correspondence to Amiethab A. Aiyer .

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An, T.W., Kish, A., Varacallo, M., Aiyer, A.A., Vulcano, E. (2017). Lisfranc Injuries. In: Eltorai, A., Eberson, C., Daniels, A. (eds) Orthopedic Surgery Clerkship. Springer, Cham. https://doi.org/10.1007/978-3-319-52567-9_84

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  • DOI: https://doi.org/10.1007/978-3-319-52567-9_84

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  • Publisher Name: Springer, Cham

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