Questions and Answers
How common are Lisfranc injuries?
The Lisfranc joint complex is stabilized by its unique bone structure, as well as by strong ligaments and surrounding soft tissues, which is more robust on the plantar aspect.
True
Describe the sagittal motion of the 3 functional columns of the Lisfranc joint.
Medial - 3.5mm, Central - 0.6mm, Lateral - 13mm
Describe the ligamentous anatomy of the Lisfranc joint.
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What tendon can often impair a reduction of a laterally dislocated Lisfranc joint?
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What is the mechanism for Lisfranc injuries?
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What is the most utilized classification for Lisfranc injuries?
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How accurate is the Hardcastle classification?
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What are the 5 P's of compartment syndrome?
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What is possibly the most important treatment/goal that drives positive outcomes of Lisfranc fractures/dislocations?
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What is the consensus on surgical treatment of Lisfranc injuries?
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Describe the surgical approach for a Lisfranc repair.
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What is the blood supply to the navicular?
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Where is the most difficult place of the navicular to heal?
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What are the different types of cuboid fractures?
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What is the most common cuboid fracture?
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Study Notes
Lisfranc Injuries
- Lisfranc injuries occur in approximately 0.2% of all fractures; overall prevalence may be underreported.
- The Lisfranc joint complex is stabilized by unique bone structure, strong ligaments, and robust surrounding soft tissues, especially on the plantar aspect.
- Common mechanisms of injury include direct impact or indirect rotational forces.
Functional Anatomy
- Sagittal motion in the three functional columns of the Lisfranc joint:
- Medial: 3.5 mm
- Central: 0.6 mm
- Lateral: 13 mm
- Ligamentous anatomy consists of dorsal, interosseous, and the strongest plantar ligaments.
Anatomical Considerations
- The anterior tibialis tendon can impair reduction in laterally dislocated Lisfranc joints.
Classification Systems
- Utilized classification systems for Lisfranc injuries include Myerson and Hardcastle.
- The Hardcastle classification has moderate intra-observer reliability.
Diagnostic Imaging
- X-ray signs of a Lisfranc injury may include lateral dislocation of tarsal-metatarsal joints, the Fleck sign, and dorsal dislocation of the second metatarsal base.
- On an AP view, look for congruence of the medial cortex of the second metatarsal base and the intermediate cuneiform.
- An MO view should show congruence of the medial cortex of the fourth metatarsal base and the cuboid.
- If X-rays are inconclusive, a CT scan can be conducted.
Post-Injury Information
- Swelling and intradermal edema peak at 36 hours after fracture.
- Compartment syndrome signs include pain, pallor, pulselessness, paresthesias, and paralysis.
Treatment Strategies
- Anatomic reduction is crucial for positive outcomes in Lisfranc fracture/dislocations.
- There is no consensus on surgical treatment; properly performed ORIF yields results similar to primary fusion of the first and second rays.
Surgical Approaches & Postoperative Care
- Surgical repair usually starts medially and progresses laterally.
- Post-operative treatment specifics are necessary following a Lisfranc injury repair.
Navicular Trauma
- Blood supply to the navicular comes from the posterior tibial artery (plantar) and dorsalis pedis artery (dorsal).
- The central one-third of the navicular is the most challenging area to heal due to its watershed nature.
- Common location for navicular avulsion fractures is medial, from the posterior tibialis tendon, and plantar, from the spring ligament.
Navicular Fracture Treatments
- Management options for various fractures include conservative treatments for minimally displaced fractures and surgical interventions for displaced fractures.
Cuboid Fractures
- Types of cuboid fractures include compression, avulsion, and crush injuries.
- The most common is an avulsion fracture from the lateral aspect, associated with the calcaneocuboid ligament.
Treatment of Cuboid Fractures
- Treatment strategies for avulsion fractures and compression fractures vary, often requiring immobilization and possible surgical intervention.
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Description
This quiz delves into the specifics of Lisfranc injuries, covering prevalence, mechanisms of injury, and functional anatomy. Understand the classifications and diagnostic imaging techniques associated with these complex injuries.
