lisfranc1.png

Lisfranc injury

  • Disruption between the articulation of the medial (1st) cuneiform and base of the second metatarsal à disruption of the TMT joint complex

  • Injuries can range from mild sprains to severe dislocations. May take form of purely ligamentous injuries or fracture-dislocations

  • the Lisfranc articulation is stabilized by several ligaments

    • Lisfranc ligament ( plantar, C1-M2)

    • Plantar tarsometatarsal ligament

    • Dorsal tarsometatarsal ligament (weak, explaining the frequent dorsal dislocation)

    • Intermetatarsal ligaments (no ligament between M1-M2)

 
Lisfranc.jpg
 

Physical exam

  • medial plantar bruising

  • swelling throughout midfoot

  • tenderness over tarsometatarsal joint

  • instability test

    • grasp metatarsal heads and apply dorsal force to forefoot while other hand palpates the TMT joints: dorsal subluxation suggests instability. If the plantar ligaments are intact, there is no dorsal subluxation, and conservative treatment can be done.

lisfanc6.png

Imaging

  • Xrays : AP+L

  • CT scan useful for diagnosis and preoperative planning

  • MRI can be used to confirm presence of purely ligamentous injury

lisfranc3.png
lisfranc4.jpg
dorsal subuxation

dorsal subuxation

MRI showing pure ligament disruption

MRI showing pure ligament disruption

CT scan 3D reconstruction

CT scan 3D reconstruction

lisfranc surgery.png

Treatment

  • Nonoperative : cast immobilization for 8 weeks : indications

    • no displacement on weight-bearing and stress radiographs and  no evidence of bony injury on CT (usually dorsal sprains)

    • certain nonoperative candidates, even if displaced

      • nonambulatory patients

      • presence of serious vascular disease

      • severe peripheral neuropathy instability in only the transverse plane

  • Operative:

    • open reduction and rigid internal fixation ( in bony lesions)

    • primary arthrodesis of the first, second and third tarsometatarsal joints (in ligamentous lesion. Generally in chronic cases)

    • midfoot arthrodesis: chronic lisfranc injuries that have led to advanced midfoot arthrosis and have failed conservative therapy

chopart1.png

Chopart injury

  • The Chopart complex consists of two separate but interrelated joints. These include the talonavicular (TN) joint on the medial side and the calcaneocuboid (CC) joint laterally, which separate the hindfoot from the midfoot

  • Injury results of a low-energy twisting force applied to the plantarflexed foot

  • Generally a CT scan is needed.

  • Treatment is functionnal for pure ligamentous injuries or avulsions. short leg cast is applied for non displaced fractures.

  • Surgery is required for displaced fractures or dislocation.

  • As Lisfranc’s injury, Chopart’s lesion will frequently leads to osteoarthritis, and thus, patients will require arthrodesis (bone fusion)

This information is a brief, simple medical explanation. For exhaustive details, and before starting any kind of treatment, please refer to Dr.BAYOUD