Tarsal-Metatarsal (Lisfranc) Dislocation

Lenczner, Eric; Jp, Waddell; Graham, John D.

doi:10.1097/00005373-197412000-00003

Cited by 40 publications

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“…Occasionally, soft tissue may be interposed and dislocation of the tendon of tibialis anterior between the middle and medial columns into the medial tarsal metatarsal joint has been reported. 22,23 Once the base of the second metatarsal has been reduced anatomically, the first metatarsal is positioned correctly on the medial cuneiform. Generally, there is abduction of the first metatarsal, the hallux is grasped, and the base of the first metatarsal is pushed laterally (Fig.…”

Section: Treatmentmentioning

confidence: 99%

“…Although high-energy injuries often produce abraded or crushed articular surfaces, which may develop arthritis despite appropriate reduction, most studies have found that the subsequent development of degenerative changes is markedly increased if the extent of the injury has initially been unrecognised, if the injury has been only partially treated, or if the anatomy was not restored. 23,[30][31][32][33] In an earlier retrospective study, Komenda et al 10 evaluated 32 patients who had had tarsometatarsal arthrodesis for intractable pain after trauma of the midfoot and found that in most the extent of the injury had not been appreciated and the reduction was inadequate.…”

Section: Post-traumatic Arthritismentioning

confidence: 99%

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The Diagnosis and Treatment of Injury to the Tarsometatarsal Joint Complex

Myerson

1999

The Journal of Bone and Joint Surgery. British volume

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Although the eponym 'Lisfranc dislocation' is still often used to describe injuries to the tarsometatarsal joints, the term is misleading. It probably originated from the time of Napoleon and relates to injury to the foot sustained in falling from a horse, accompanied by severe vascular damage which necessitated amputation, the only method of treatment used by Lisfranc, surgeon to the Emperor. Since then, the incidence of severe vascular complications associated with injuries to the tarsometatarsal joint has declined to the extent that the only circumstances under which circulatory compromise is treated is in the presence of a compartment syndrome. Injuries to the midfoot are best described as those affecting the tarsometatarsal joint complex (TMC) which includes all the bones and joints directly or indirectly involved in a tarsometatarsal fracture-dislocation, including the cuneiforms, cuboid, and navicular. Although high-energy injuries to the TMC occur commonly today after motor-vehicle, motorcycle, and industrial accidents, they may also be seen in association with minimal trauma from minor twisting injuries, particularly in athletes and the elderly. The concepts of the treatment of injury to the TMC have changed markedly over the past decade. In 1986, Myerson et al 1 highlighted the severe morbidity associated with these injuries and identified the factors associated with a poor outcome, particularly residual angulation of the metatarsals or diastasis of greater than 2 mm between the base of the first and second metatarsals. Failure to obtain an anatomical reduction is the most significant reason for a poor result. In these patients, the treatment had either been non-operative or, if surgery had been performed, Kirschner wires (K-wires) had been used for fixation. It was further recognised that premature removal of these K-wires resulted in subsequent diastasis or redislocation. Arntz, Veith and Hansen 3 first popularised the use of screws in preference to K-wires and, since then, there have been a number of papers emphasising the need for anatomical reduction stabilised by rigid forms of internal fixation.2,4-8The aim of treatment should always be to obtain such a reduction and then to maximise the function of the foot. Unfortunately, the magnitude of this type of injury is often not appreciated because partial spontaneous reduction of the joint complex may mask the true extent of the injury. Even apparently minor injuries with subtle subluxation and diastasis of the articulation have marked morbidity if left untreated. 2,6,9 Functional anatomy of the tarsometatarsal joints A review of the functional anatomy and diagnosis of this injury will promote a better understanding of the concepts of treatment.The tarsometatarsal articulation consists of three functional units, previously referred to as columns. 10 The medial column, formed by the base of the first metatarsal and the medial cuneiform, allows approximately 3.5 mm of dorsal plantar movement. The second metatarsal and the middle cuneiform with the thir...

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Section: Treatmentmentioning

confidence: 99%

Section: Post-traumatic Arthritismentioning

confidence: 99%

The Diagnosis and Treatment of Injury to the Tarsometatarsal Joint Complex

Myerson

1999

The Journal of Bone and Joint Surgery. British volume

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“…However, even with accurate diagnosis and early treatment, these injuries can result in chronic disability 5 . Over the past several decades, Lisfranc complex injuries have been treated with closed reduction and immobilization, closed reduction and percutaneous pinning 3,[6][7][8][9] , or open reduction and percutaneous pinning or screw fixation [10][11][12][13] . It has become evident that an anatomic reduction is critical for optimal outcomes and that this is best achieved with open reduction 7,[11][12][13] .…”

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confidence: 99%

Treatment of Primarily Ligamentous Lisfranc Joint Injuries: Primary Arthrodesis Compared with Open Reduction and Internal Fixation<sbt aid="1080838">A Prospective, Randomized Study</sbt>

Coetzee

2006

J Bone Joint Surg Am

209

320

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“…These changes, which range from slight degenerative changes to complete loss of joint space, were presented in 80 (49.6%) out of 161 patients (62.6%) in seven studies [2,17,21,23,34,38,39]. Many authors have concluded that the development of degenerative changes is markedly increased if the presence or the extent of injury has initially been unrecognised, if the injury has been only partially treated, if the anatomy was not restored, or even if the injury was purely ligamentous and not osseoligamentous [1,3,8,10,19,35]. Additionally, one should take into consideration that the initial articular cartilage damage that occurs at the time of injury cannot be estimated preoperatively, but it is only appreciated after an adverse outcome becomes obvious.…”

Section: Discussionmentioning

confidence: 99%

The role of reduction and internal fixation of Lisfranc fracture–dislocations: a systematic review of the literature

Stavlas

Roberts

Xypnitos

et al. 2010

International Orthopaedics (SICOT)

141

127

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A systematic review of the literature was performed in order to evaluate the role of reduction and internal fixation in the management of Lisfranc joint fracturedislocations. Articles were extracted from the Pubmed database and the retrieved reports were included in the study only if pre-specified eligibility criteria were fulfilled. Eleven articles were eligible for the final analysis, reporting data for the management of 257 patients. Injuries of the first three metatarsal rays were treated by closed reduction and internal fixation with screws in 16.3% of the patients, open reduction and internal fixation with screws in 66.5% and open reduction and internal fixation with Kirschner wires (K-wires) in 17.1% of the patients. The preferred method for the stabilisation of the fourth and fifth metatarsal rays was K-wires. Screw-related complications were common and were reported in 16.1% of the cases. The mean American Orthopaedic Foot and Ankle Society midfoot score was 78.1 points. Post-traumatic radiographic arthritis was reported in 49.6% of the patients, but only in 7.8% of them it was severe enough to warrant an arthrodesis. We conclude that open reduction and internal fixation of the first three metatarsal rays with screws is a reliable method for the management of Lisfranc injuries. This can be complemented by K-wires application in the fourth and fifth metatarsal rays if needed.

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Tarsal-Metatarsal (Lisfranc) Dislocation

Cited by 40 publications

References 0 publications

The Diagnosis and Treatment of Injury to the Tarsometatarsal Joint Complex

The Diagnosis and Treatment of Injury to the Tarsometatarsal Joint Complex

Treatment of Primarily Ligamentous Lisfranc Joint Injuries: Primary Arthrodesis Compared with Open Reduction and Internal Fixation<sbt aid="1080838">A Prospective, Randomized Study</sbt>

The role of reduction and internal fixation of Lisfranc fracture–dislocations: a systematic review of the literature

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