foot trauma

1. LISFRANC INJURIES
PEREPARED BY :
MOHD ALATTAS
Orthopaedic resident R1)
)

2. INTRODUCTION
What is it?
 tarsometatarsal injuries .
 anatomic boundary between the rigid
midfoot and the suppler weightbearing
forefoot.
 Why it is called LISFRANC ????

3. INTRODUCTION
Frequency:
 1 per 55,000 persons per year.
Etiology:
1. low-energy loading observed in sports-
related injuries
2. high-energy loading observed in motor
vehicle and industrial accidents.

4. Anatomy & Biomechanics
5 TMT joints :
 medial 3 MT with cunieforms and lateral
2 with cuboid. a recess formed by the
second TMT joint . So what ?

5. ligaments :
1. thick plantar ligaments that form an
interlocking pattern between the tarsal
and MT bones.
2. series of intermetatarsal ligaments,. No
intermetatarsal ligaments exist between
the first and second MTs.
3. Lisfranc ligament , the only soft-tissue
link between the medial ray and the
lesser MT and is responsible for the
area's stability.

6.  2/3 of the motion in TMT joints occur in
the lateral ray ( helps in uneven grounds )
 The transverse arch and the longtudinal
arch are rigids so protect planter
structures from compression dyring W.B
 The arch rigidity helps transfering ceter of
motion from ankle to forefoot so allows
smooth heel left and transfering wt to the
other leg.

7. The stability of lisfranc complex depends on:
1. The second TMT joint recess.
2. The ligaments.

8. Anatomy & Biomechanics

9. CLASSIFICATION

11. CLINICALY
 obvious anatomic
deformities to only
pain with
weightbearing .
 signs :
• Plantar midfoot
ecchymosis.
• Pain along the TMT
joints with palpation,
motion, and/or
weightbearing
• Midfoot instability

12. RADIOLOGY
1. Anteroposterior (AP) view of the foot in a standing position
if possible, to asses area b/w 1st & 2nd TMT

13. RADIOLOGY
 30 Medial oblique view of the foot ,to asses area
b/w 3rd &4th

14. RADIOLOGY
 Lateral view of the foot in a standing position if
possible ,helps in assesment of dorsum of 2nd
MT with middle ceuniform.

15. RADIOLOGY
 If the patient is unable to bear weight??
stress views with an ankle block or with
intravenous sedation
 CT scan through the midfoot is suggested
to visualize any bony injury to the plantar
bony structures
 Bone scan is best used for suspected
chronic injuries of the TMT joints.

16. RADIOLOGY

17. MANAGEMENT
Important factors:
1- stability and severity of the injury
2- associated fracture:
 extraarticular : treated as recommended for such fracture
 intraarticular : treated as part of the joint injury , If greater
than 50% of the joint surface of the medial 3 joints is
destroyed, seriously consider acute fusion of these joints.
lateral 2 joints, they should never undergo acute fusion.

18. MANAGEMENT
 Anatomically stable(sprains or
displacement less than 2mm):
 RICE + immobilization in short leg NWB cast
for 6 weeks , recheck after 10 days for
stability , progressive WB in protective brace
and P.T as tolerated

19. MANAGEMENT
 Unstable :
 what is the role of closed reduction and
casting ?
 Present recommendations for treatment
consist of open reduction of the unstable area
and rigid fixation with 3.5-mm fixation screws.
Multiple (K-wires) also have been advocated,
but maintaining reduction with them is more
difficult

20. MANAGEMENT

21. MANAGEMENT
 Post op : NWB and cast for 6-8 weeks
then progressive WB as tolerated
 Follow-up care:
 6-week postoperative visit, radiographically
assess of healing. If k-wires are used, they
should be removed.
 Follow up on a monthly basis until full
weightbearing is achieved .

22. COMPLICATIONS
 Nonanatomic reduction or alignment
 Posttraumatic arthritis
 Pain with weightbearing

23. OUTCOME AND PROGNOSIS
 Anatomic alignment is the best predictor
of outcome. The presence of fractures
and/or articular destruction leads to poorer
results, regardless of alignment.