LisFranc and Midfoot Fractures Flashcards

Study Notes

Fleck's Sign

Indicative of a LisFranc injury.
Characterized by a fragment of bone avulsed from the base of the 2nd metatarsal or 1st cuneiform.

Signs and Symptoms of LisFranc Injury

Symptoms include ecchymosis, edema, midfoot pain, and potential for compartment syndrome.

Stress Maneuvers for LisFranc Injury

Diagnostic tests performed in the operating room.
Involves stabilizing the rearfoot and stressing the forefoot, assessing pain during the piano stress test.

Symptoms Indicative of LisFranc Injury

Presence of ecchymosis, edema, midfoot pain, and pain elicited during stress maneuvers.

Late Treatment Prognosis

Delayed intervention correlates with a worse prognosis.

Vassal's Principle in Midfoot Anatomy

Major fracture fragments should be realigned, causing smaller fragments to align naturally.

Midfoot Injury Susceptibility

Shallower recess in anatomy increases likelihood of injury.

Osseous Stability of the Midfoot

Comprised of two arches (longitudinal and transverse) and three columns providing structural stability.

TMT Joint Soft Tissue Stability

Ligaments across the TMT joint include strong plantar ligaments and weaker dorsal ligaments.
Secondary stabilizers include the plantar fascia and peroneus longus tendon.

Tarsometatarsal Joint Motion

The 1st-3rd tarsometatarsal joints exhibit minimal motion in both sagittal and frontal planes.

Age Demographics for LisFranc Injury

Commonly presents in individuals during their 3rd decade of life.

Quenu and Kuss Classification

Classifies injuries as homolateral, isolated, or divergent types.

Nunley and Vertullo Classification

Stage 1 indicates no diastasis; Stage 2 indicates a ruptured ligament with 2-5mm diastasis; Stage 3 indicates both features plus loss of longitudinal arch height.

Hardcastle Classification

Type A indicates total incongruity; types B1 and B2 denote partial incongruity with either medial or lateral dislocation; types C1 and C2 indicate partial and total displacement respectively.

Imaging Techniques for LisFranc Injury

Definitive x-rays lead directly to surgery.
Stress x-rays performed intraoperatively; MRI is best for chronic issues, while CT is preferred for acute presentations.

X-ray Findings in LisFranc Injury

Look for diastasis greater than 1mm between intermetatarsal and intercuneiform spaces, and check for Fleck sign.

Surgical Indications and Goals for LisFranc Injury

Indication for surgery includes any displacement, aiming for anatomic realignment.
Non-displaced injuries require careful assessment of soft tissue stability.

Incision Strategies for Surgical Access

Incision placement should avoid damaging deep peroneal nerve and deep plantar artery; careful placement can improve soft tissue preservation.

Forms of Fixation in LisFranc Surgery

Options include K-wire only, screws with K-wire, bridge plate, or endobutton; the key focus should be on achieving anatomic reduction.

Surgical Treatment Varieties

ORIF is ideal for lower energy injuries; primary arthrodesis is better suited for higher energy injuries requiring patient downtime.

Functional Outcomes Following Surgery

Post-operative risks include post-traumatic arthritis, hardware complications, and loss of joint function.

Post-Operative Care

Non-weight bearing (NWB) protocol for 8 weeks; gradual weight increase and physical therapy follow.

Midfoot and Navicular Fracture Classifications

Various classification systems categorize fractures based on location and angulation, e.g., the Sangeorzan and Watson-Jones classifications for navicular fractures.

Treatment of Midfoot and Cuboid Fractures

Surgical options include arthrodesis or arthroplasty; direct visualization is essential for complex fractures to ensure joint restoration.

STJ Dislocations Insights

Dislocation direction is dependent on the relationship between distal and proximal parts; most common dislocation is medial (80%).

Closed Reduction Techniques for STJ Dislocations

Specific steps vary for medial and lateral dislocations, emphasizing careful traction and adjustments to the position of the foot for optimal reduction.

Post-Reduction Management of STJ Dislocations

Stable dislocations may simply require casting; if unstable, surgical intervention may be necessary through pinning or arthrodesis.

Complications of STJ Dislocation

Risks include osteochondral lesions, open fractures, and soft tissue injury, which can complicate recovery and outcomes.

Description

Study key concepts related to LisFranc and midfoot fractures through this flashcard quiz. Understand important signs, symptoms, and diagnostic maneuvers associated with these injuries. Perfect for medical students or professionals looking to refresh their knowledge on midfoot trauma.

LisFranc and Midfoot Fractures Flashcards

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Questions and Answers

What does Fleck's Sign indicate?

What are some signs and symptoms of LisFranc Injury?

What is the late treatment prognosis for LisFranc Injury?

What is Vassal's Principle related to?

The 1st-3rd tarsometatarsal joints have ______ motion in the sagittal plane.

LisFranc Injury most commonly presents in the ______ decade.

What is the most effective imaging for an acute LisFranc injury?

What is the goal of surgical treatment for LisFranc Injury?

What are indications for surgery in LisFranc Injury?

What complications can arise if anatomical reduction is not achieved in LisFranc injuries?

When fixating a LisFranc injury, the procedure should go from ______ to ______.

What sign indicates that swelling has decreased in a patient?

What surgical goals are there for treating STJ dislocations?

Which type of LisFranc Injury classification involves no diastasis?