Tarsometatarsal Injuries Quiz
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Questions and Answers

What is a common imaging modality to detect injuries to the tarsometatarsal joint complex?

  • Endoscopy
  • MRI (correct)
  • X-ray (correct)
  • Ultrasound

    • Which type of tarsometatarsal injury typically requires surgical intervention?

  • Stable injuries
  • All unstable injuries (correct)
  • Chronic deformities
  • Acute fractures

    • What is one of the purposes of understanding the anatomy and mechanisms of tarsometatarsal injuries?

  • To develop preventative measures for athletes
  • To assess treatment options and prognosis (correct)
  • To minimize rehabilitation time
  • To create new imaging techniques

    • Which type of injury may be treated conservatively?

    <p>Stable injuries</p> Signup and view all the answers

    What is a potential outcome of injuries to the tarsometatarsal joint complex?

    <p>Chronic deformity</p> Signup and view all the answers

    Which publication specifically addresses the epidemiology of foot and ankle injuries in sports?

    <p>Clin Sports Med</p> Signup and view all the answers

    What factor is primarily considered when diagnosing tarsometatarsal injuries?

    <p>Radiographic evidence and mechanism of injury</p> Signup and view all the answers

    What is the consequence of not correctly diagnosing a tarsometatarsal injury?

    <p>Increased injury severity</p> Signup and view all the answers

    Which ligament is specifically described as being absent between the first and second metatarsals?

    <p>TMT ligament</p> Signup and view all the answers

    What is the primary direction in which dislocations occur in the Lisfranc joint complex?

    <p>Dorsal direction</p> Signup and view all the answers

    Which ligament arises from the lateral surface of the medial cuneiform?

    <p>Lisfranc ligament</p> Signup and view all the answers

    Among the ligaments, which type is described as being stronger in the plantar aspect compared to the dorsal aspect?

    <p>Plantar ligaments</p> Signup and view all the answers

    How many TMT ligaments are noted in the Lisfranc joint complex?

    <p>7</p> Signup and view all the answers

    What is the relationship between the intertarsal dorsal ligaments and the cuneiforms and cuboid?

    <p>They uniting the cuneiforms and cuboid</p> Signup and view all the answers

    Which ligament is stated to be the strongest of the plantar ligaments?

    <p>Second plantar Lisfranc ligament</p> Signup and view all the answers

    Which statement correctly describes the strength comparison between medial and lateral ligaments in the Lisfranc complex?

    <p>Medial ligaments are stronger than lateral ligaments</p> Signup and view all the answers

    What is the recommended imaging technique for patients with equivocal findings on non-weight bearing (NWB) radiographs?

    <p>Weight bearing (WB) radiographs</p> Signup and view all the answers

    For which stage of Lisfranc injury is nonoperative treatment primarily indicated?

    <p>Stage I</p> Signup and view all the answers

    What is the primary goal in managing a Lisfranc injury?

    <p>Maintaining anatomic alignment</p> Signup and view all the answers

    When should stress radiographs under anesthesia be considered?

    <p>When MR imaging findings are equivocal</p> Signup and view all the answers

    What management approach is recommended for unstable Lisfranc injuries?

    <p>Open reduction and internal fixation (ORIF)</p> Signup and view all the answers

    What indicates that a patient may be treated nonsurgically for a Lisfranc injury?

    <p>Minimal ambulatory ability and insensate foot</p> Signup and view all the answers

    What is crucial to rule out occult instability two weeks after initial presentation?

    <p>Serial physical examinations and repeat WB radiographs</p> Signup and view all the answers

    What should patients with stable Lisfranc injuries initially receive to protect the soft tissues?

    <p>Controlled ankle motion walking boot</p> Signup and view all the answers

    What is a key advantage of CT imaging over MR imaging in evaluating fractures?

    <p>CT is superior in detecting fractures and subtle displacement.</p> Signup and view all the answers

    In which scenario is it recommended to use CT imaging?

    <p>Identifying high-energy midfoot injuries.</p> Signup and view all the answers

    What might MR imaging mistakenly misinterpret in a fracture assessment?

    <p>Bone bruises as small avulsion fractures.</p> Signup and view all the answers

    What imaging technique is beneficial for preoperative surgical planning in complex fractures?

    <p>Three-dimensional (3D) volume rendering (VR) images.</p> Signup and view all the answers

    What is the ideal orientation for the CT beam angle when imaging the injured foot?

    <p>Along the metatarsals as they meet with tarsal bones.</p> Signup and view all the answers

    What could be the significance of tarsometatarsal malalignment seen on MR imaging without other abnormalities?

    <p>Its significance is uncertain.</p> Signup and view all the answers

    Which imaging technique is superior for direct visualization of soft tissue structures?

    <p>MR imaging.</p> Signup and view all the answers

    Which imaging sequence is recommended to assess complicated fractures that may not be easily identifiable?

    <p>Non-fat-saturated T1-weighted sequence.</p> Signup and view all the answers

    What is the primary focus of Myerson et al.'s 1986 study?

    <p>Fracture dislocations of the tarsometatarsal joints</p> Signup and view all the answers

    Which sign is associated with diagnosing Lisfranc tarsometatarsal injuries?

    <p>Plantar ecchymosis sign</p> Signup and view all the answers

    Which imaging technique was highlighted for evaluating Lisfranc joint diastasis according to Panchbhavi et al.?

    <p>Three-dimensional evaluation</p> Signup and view all the answers

    What type of joint injuries does Hatem focus on in his 2008 publication?

    <p>Tarsometatarsal joint injuries</p> Signup and view all the answers

    What aspect of Lisfranc injuries is emphasized in the systematic review by Stavlas et al.?

    <p>Role of reduction and internal fixation</p> Signup and view all the answers

    Which medical journal published the study by Lau et al. on Lisfranc fracture dislocation?

    <p>Emerging Medicine Journal</p> Signup and view all the answers

    What diagnostic technique is associated with identifying subtle tarsometatarsal pathology?

    <p>MRI with anatomic correlation</p> Signup and view all the answers

    What does the study by Gupta et al. focus on regarding Lisfranc injuries?

    <p>Imaging findings</p> Signup and view all the answers

    What imaging technique was specifically evaluated for the Lisfranc ligament in cadaveric feet?

    <p>3D-SPACE sequence</p> Signup and view all the answers

    Which study discusses the prediction of midfoot instability in subtle Lisfranc injuries?

    <p>Raikin et al.</p> Signup and view all the answers

    Which treatment method was compared with primary arthrodesis for ligamentous Lisfranc joint injuries?

    <p>Open reduction and internal fixation</p> Signup and view all the answers

    What biomechanical analysis was conducted regarding Lisfranc injury fixation devices?

    <p>Comparison of dorsal plate and transarticular screw fixation</p> Signup and view all the answers

    In which year was the biomechanical analysis of a tensioned suture device published?

    <p>2011</p> Signup and view all the answers

    Which option correctly identifies the study that evaluates outcomes after open reduction and internal fixation of Lisfranc joint injuries?

    <p>Kuo RS et al.</p> Signup and view all the answers

    What is the focus of the research by Alberta FG et al. regarding Lisfranc joint injuries?

    <p>A biomechanical comparison of fixation methods</p> Signup and view all the answers

    Which study addresses the treatment of primarily ligamentous Lisfranc injuries?

    <p>Ly TV and Coetzee JC</p> Signup and view all the answers

    What type of injuries typically result from high-energy direct force applied to the dorsum of the foot?

    <p>Plantar or dorsal dislocations of metatarsals</p> Signup and view all the answers

    Which group classified athletic midfoot injuries based on clinical findings and radiographs?

    <p>Nunley and Vertullo</p> Signup and view all the answers

    What typically characterizes indirect injuries to the midfoot?

    <p>Arise from either high-energy or low-energy forces</p> Signup and view all the answers

    What is a noted challenge in diagnosing low-energy Lisfranc injuries?

    <p>Their clinical and radiologic findings can be subtle</p> Signup and view all the answers

    According to the classifications mentioned, which type of Lisfranc injuries is characterized by metatarsal displacement?

    <p>Lisfranc fracture-dislocations</p> Signup and view all the answers

    What type of injuries are associated with multiple atypical tarsal fractures and extensive soft tissue injuries?

    <p>High-energy direct injuries</p> Signup and view all the answers

    What is a significant factor distinguishing high-energy crush injuries?

    <p>They often result in worse injuries than indirect injuries</p> Signup and view all the answers

    Which classification system is not useful for low-energy injuries without fractures?

    <p>Fracture-dislocation classification systems</p> Signup and view all the answers

    What is the main reason CT is preferred in assessing midfoot injuries from high-energy trauma?

    <p>CT provides superior multiplanar reformatted data.</p> Signup and view all the answers

    In what scenario might MR imaging misidentify avulsion fractures?

    <p>By misdiagnosing them as bone bruises.</p> Signup and view all the answers

    What is a potential limitation of MR imaging when assessing midfoot injuries?

    <p>Uncertainty in the significance of malalignment.</p> Signup and view all the answers

    Why is a small field of view recommended when performing imaging for midfoot injuries?

    <p>To enhance the detection of subtle fractures.</p> Signup and view all the answers

    Which imaging technique is specifically beneficial for preoperative surgical planning in complex fractures?

    <p>Three-dimensional (3D) volume rendering images.</p> Signup and view all the answers

    What is the effect of the CT beam angle orientation when imaging the injured foot?

    <p>It should align with the metatarsals.</p> Signup and view all the answers

    What is a common limitation of using MR imaging compared to CT in fracture detection?

    <p>MR often misses subtle fractures.</p> Signup and view all the answers

    What is a key aspect of performing imaging to visualize the ligament complex in the injured foot?

    <p>Utilizing both axial and coronal imaging planes.</p> Signup and view all the answers

    What imaging technique has been found to reveal significantly more fractures in the metatarsals when compared to traditional radiography?

    <p>Computed tomography (CT)</p> Signup and view all the answers

    What is the expected recovery time from a nonoperative Lisfranc injury?

    <p>4 months</p> Signup and view all the answers

    What is considered abnormal in abduction stress radiographs if the diastasis exceeds how many millimeters?

    <p>2 mm</p> Signup and view all the answers

    In what situation is surgical intervention indicated for foot injuries?

    <p>Displaced fractures</p> Signup and view all the answers

    Why are stress radiographs typically performed under anesthesia?

    <p>To allow for real-time assessment of dynamic instability</p> Signup and view all the answers

    In the context of Lisfranc injuries, what does a normal finding on weight-bearing radiographs still warrant?

    <p>Proceeding with stress radiographs if clinical suspicion remains high</p> Signup and view all the answers

    What can lead to the failure of closed reduction in foot injuries?

    <p>Interposition of a bone fragment</p> Signup and view all the answers

    What surgical method is reported to best restore anatomical reduction for subtle Lisfranc injuries?

    <p>Open reduction</p> Signup and view all the answers

    Which finding on imaging is indicative of instability in Lisfranc injuries?

    <p>Diastasis of 2 mm or more</p> Signup and view all the answers

    What type of imaging modality may be indicated for assessing occult foot injuries?

    <p>MRI</p> Signup and view all the answers

    What advantage does computed tomography (CT) have over standard radiography in the evaluation of foot injuries?

    <p>Enhanced visualization of complex fractures</p> Signup and view all the answers

    What specific circumstance should prompt the use of stress radiographs after initial imaging?

    <p>High clinical suspicion despite normal findings</p> Signup and view all the answers

    Which surgical method utilizes fluoroscopic visualization?

    <p>Closed reduction</p> Signup and view all the answers

    What is a common characteristic of unstable Lisfranc injuries?

    <p>They may be subtle and require surgical management.</p> Signup and view all the answers

    What is a key outcome from a study that contrasts findings of CT versus radiography in foot fractures?

    <p>CT revealed significantly more metatarsal fractures</p> Signup and view all the answers

    Which type of fixation method can be used after closed reduction fails?

    <p>Hybrid internal and external fixation</p> Signup and view all the answers

    What type of imaging technique is advantageous for identifying the severity of tarsometatarsal injuries?

    <p>Stress radiographs</p> Signup and view all the answers

    Which anatomical understanding is critical for diagnosing tarsometatarsal injuries?

    <p>Mechanisms and patterns of injury</p> Signup and view all the answers

    What is the primary consideration in determining the treatment approach for tarsometatarsal injuries?

    <p>Stability of the injury</p> Signup and view all the answers

    Which population is indicated for conservatively treating Lisfranc injuries?

    <p>Patients with stable injuries</p> Signup and view all the answers

    What can advanced imaging modalities, such as CT and MR imaging, provide in the assessment of tarsometatarsal injuries?

    <p>Assessment of joint instability</p> Signup and view all the answers

    What outcome is most likely if a tarsometatarsal injury goes undiagnosed?

    <p>Severe chronic deformity</p> Signup and view all the answers

    What alternative imaging technique is mentioned for assessing tarsometatarsal joint injuries?

    <p>Weight-bearing radiographs</p> Signup and view all the answers

    Which complication is frequently associated with tarsometatarsal joint injuries in athletes?

    <p>Chronic instability</p> Signup and view all the answers

    What is the significance of having a talometatarsal angle greater than 15 degrees in radiographic assessment?

    <p>It suggests potential metatarsal subluxation.</p> Signup and view all the answers

    Which radiographic finding is most characteristic of Lisfranc injuries?

    <p>Lateral step-off at the medial margin of M2.</p> Signup and view all the answers

    What does the absence of a step-off at the dorsal margins of the TMT joints suggest?

    <p>An absence of significant joint instability.</p> Signup and view all the answers

    How is the distance between the plantar cortex of C1 and M5 relevant in diagnosing Lisfranc injuries?

    <p>Reduced distance may indicate dorsal subluxation.</p> Signup and view all the answers

    In an anteroposterior radiograph, what is a concerning finding in terms of the first and second metatarsals?

    <p>Widening greater than 2 mm.</p> Signup and view all the answers

    What does the presence of a bone fragment at C1-M2 in radiographic findings suggest?

    <p>It is associated with Lisfranc injuries.</p> Signup and view all the answers

    What is the expected measurement for the talometatarsal angle to be considered normal?

    <p>Less than 10 degrees.</p> Signup and view all the answers

    Which finding indicates a widening greater than 1 mm at M1-M2?

    <p>A potential Lisfranc injury.</p> Signup and view all the answers

    What is the primary reason for prompt diagnosis and treatment of a Lisfranc injury?

    <p>To avoid osteoarthritis and chronic deformity</p> Signup and view all the answers

    Which mechanism of injury is most commonly associated with Lisfranc injuries?

    <p>Motor vehicle accidents</p> Signup and view all the answers

    What percentage of athletic injuries does Lisfranc injury account for?

    <p>Approximately 15%</p> Signup and view all the answers

    Which imaging modality is primarily important for the diagnosis and management of low-energy Lisfranc injuries?

    <p>Computed tomography (CT)</p> Signup and view all the answers

    What should not be classified as a Lisfranc injury?

    <p>Metatarsal fractures without TMT subluxation</p> Signup and view all the answers

    What is the primary indication for performing stress radiographs under anesthesia for Lisfranc injuries?

    <p>When MR imaging findings are inconclusive</p> Signup and view all the answers

    What condition suggests that a patient may be suitable for nonoperative management of a Lisfranc injury?

    <p>Stable, nondisplaced injury</p> Signup and view all the answers

    Which aspect is crucial for the management of Lisfranc injuries irrespective of injury severity?

    <p>Achieving painless, stable foot alignment</p> Signup and view all the answers

    What is the role of imaging in assessing patients with equivocal findings on NWB radiographs?

    <p>To determine the risk of occult instability</p> Signup and view all the answers

    What differentiates stable from unstable Lisfranc injuries according to Nunley and Vertullo classification?

    <p>The degree of displacement observed in radiographs</p> Signup and view all the answers

    What is a critical consideration for radiologists when assessing tarsometatarsal injuries?

    <p>Understanding of anatomy and injury mechanisms</p> Signup and view all the answers

    Which treatment is primarily recommended for unstable injuries in the context of Lisfranc injuries?

    <p>Open reduction and internal fixation</p> Signup and view all the answers

    Which imaging modality is often utilized to assess the degree of injury in tarsometatarsal injuries?

    <p>Stress radiographs</p> Signup and view all the answers

    What is the purpose of performing serial physical examinations after initial Lisfranc injury treatment?

    <p>To monitor for signs of occult instability</p> Signup and view all the answers

    What is the primary focus of management strategies for Lisfranc injuries regardless of their classification?

    <p>Maintaining anatomic alignment throughout treatment</p> Signup and view all the answers

    How do stable tarsometatarsal injuries typically differ from unstable injuries in terms of treatment?

    <p>Stable injuries may be treated conservatively</p> Signup and view all the answers

    What imaging technique is generally deemed superior for the visualization of soft tissue structures?

    <p>MR imaging</p> Signup and view all the answers

    Which condition is associated with the need for surgical intervention in the context of tarsometatarsal injuries?

    <p>Severe instability</p> Signup and view all the answers

    What is a potential outcome of improper treatment for tarsometatarsal injuries?

    <p>Increased risk of chronic deformity</p> Signup and view all the answers

    Which of the following injuries is commonly assessed using conventional radiography in athletic settings?

    <p>Lisfranc injuries</p> Signup and view all the answers

    In terms of managing Lisfranc injuries, which factor is particularly significant to rule out after initial assessment?

    <p>Occult instability</p> Signup and view all the answers

    What is the commonly accepted finding on lateral radiographs in cases of Lisfranc injuries?

    <p>Dorsal subluxation of metatarsals at the TMT joint</p> Signup and view all the answers

    What does a talometatarsal angle greater than 15 degrees indicate?

    <p>Possible Lisfranc injuries</p> Signup and view all the answers

    In a radiographic assessment of Lisfranc injuries, what is the significance of a lateral step-off at the medial margin of the second TMT joint?

    <p>Common finding in Lisfranc injuries</p> Signup and view all the answers

    What does a finding of greater than 1 mm of widening of the M1-M2 or C1-C2 joint suggest?

    <p>Possible tarsometatarsal instability</p> Signup and view all the answers

    What anatomical structure is involved when assessing the plantar cortex of C1 in relation to M5?

    <p>Plantar cortex projections</p> Signup and view all the answers

    What imaging finding indicates reduced distance between the plantar cortex of C1 and M5?

    <p>Engendering of a Lisfranc injury</p> Signup and view all the answers

    Which of the following measurements is considered normal for the talometatarsal angle in healthy individuals?

    <p>Less than 10 degrees</p> Signup and view all the answers

    What is the clinical implication of detecting bone fragments at the C1-M2 joint in radiographs?

    <p>Presence of acute Lisfranc injury</p> Signup and view all the answers

    What specific advantage does CT imaging have over MR imaging when assessing fractures?

    <p>CT is more accurate in detecting fractures and subtle displacement.</p> Signup and view all the answers

    Which imaging modality is recommended for patients experiencing high-energy midfoot injuries?

    <p>CT scanning.</p> Signup and view all the answers

    In what context might MR imaging misinterpret a fracture situation?

    <p>It may identify bone bruises as fractures due to its sensitivity.</p> Signup and view all the answers

    What is the uncertainty associated with observed malalignment on MR imaging?

    <p>It may not correlate with ligamentous or osseous abnormalities.</p> Signup and view all the answers

    Which type of imaging plane is considered ideal for assessing the ligament complex of the injured foot?

    <p>Coronal plane perpendicular to the metatarsals.</p> Signup and view all the answers

    What imaging technique utilizes three-dimensional volume rendering for complex fracture evaluations?

    <p>Three-dimensional CT imaging.</p> Signup and view all the answers

    What imaging technique is helpful to assess for fractures that might be difficult to identify?

    <p>Non-fat-saturated T1-weighted MRI.</p> Signup and view all the answers

    Which imaging characteristic is crucial for evaluating fractures at the midfoot?

    <p>A small field of view with a targeted coil.</p> Signup and view all the answers

    What is the primary focus of the study by Myerson et al. from 1986?

    <p>Fracture dislocations of the tarsometatarsal joints and their outcomes</p> Signup and view all the answers

    Which imaging technique is emphasized for assessing Lisfranc joint diastasis?

    <p>CT imaging</p> Signup and view all the answers

    What clinical sign is highlighted as a diagnostic aid for Lisfranc tarsometatarsal injuries?

    <p>Piano key test</p> Signup and view all the answers

    What aspect of Lisfranc fracture-dislocations is discussed in the systematic review by Stavlas et al.?

    <p>Reduction techniques and internal fixation methods</p> Signup and view all the answers

    Which imaging finding is commonly associated with Lisfranc injuries, as noted by Gupta et al.?

    <p>Tarsometatarsal malalignment</p> Signup and view all the answers

    What type of injury is primarily discussed in the publication by Hatem in 2008?

    <p>Lisfranc injury and midfoot sprain</p> Signup and view all the answers

    What clinical aid for diagnosing occult Lisfranc injuries is referred to in the study by Ross et al.?

    <p>Plantar ecchymosis sign</p> Signup and view all the answers

    What is noted about the imaging findings of Lisfranc injuries in the publication by Castro et al.?

    <p>Imaging can reveal anatomical variations in the Lisfranc joint complex</p> Signup and view all the answers

    What factor indicates that surgical fixation might be necessary for a Lisfranc injury?

    <p>Severe soft tissue injury precluding internal fixation</p> Signup and view all the answers

    What is the minimum recommended duration for allowing ligamentous healing after a Lisfranc surgical fixation?

    <p>4 months</p> Signup and view all the answers

    When should a patient experiencing instability in the midfoot consider using a boot again after a Lisfranc injury?

    <p>When symptoms resolve fully</p> Signup and view all the answers

    Which factor can influence the decision to leave surgical hardware in permanently after a Lisfranc injury?

    <p>Asymptomatic condition of the patient</p> Signup and view all the answers

    For which conditions is external fixation particularly indicated in managing Lisfranc injuries?

    <p>Comminuted or osteopenic bone conditions</p> Signup and view all the answers

    What complication can arise from misdiagnosing Lisfranc injuries?

    <p>Chronic pain and early instability</p> Signup and view all the answers

    Which imaging technique is most effective for preoperative surgical planning in complex Lisfranc fractures?

    <p>Computed Tomography (CT)</p> Signup and view all the answers

    What is a potential outcome if a Lisfranc injury is not adequately treated?

    <p>Delayed healing with reduced stability</p> Signup and view all the answers

    What is the significance of the Lisfranc ligament in the tarsometatarsal (TMT) complex?

    <p>It is considered the keystone of the TMT arch, stabilizing the joint.</p> Signup and view all the answers

    Which of the following describes the interosseous ligaments in the tarsometatarsal joint?

    <p>They unite cuneiforms and the cuboid, providing powerful attachments.</p> Signup and view all the answers

    What type of forces commonly cause injuries to the tarsometatarsal joints?

    <p>Longitudinal forces applied to a plantar-flexed foot at impact.</p> Signup and view all the answers

    Which of the following best describes the location and structure of the Lisfranc ligament?

    <p>It arises inferolaterally from the medial cuneiform and is thick and short.</p> Signup and view all the answers

    How do intermetatarsal interosseous ligaments contribute to the stability of the TMT joint?

    <p>They unite the second to the fifth metatarsals, enhancing overall joint stability.</p> Signup and view all the answers

    What is the hallmark feature of a Type C injury in metatarsals?

    <p>Divergent displacement of metatarsals</p> Signup and view all the answers

    Which stage of Lisfranc injury is characterized by normal plain films but abnormal bone scans?

    <p>Stage I</p> Signup and view all the answers

    What clinical symptoms are indicative of Stage II Lisfranc injury?

    <p>Severe mid-foot swelling and a flat foot arch</p> Signup and view all the answers

    What complication must be considered when severe pain and swelling are present in a foot injury?

    <p>Compartment syndrome</p> Signup and view all the answers

    Which classification type describes total incongruity of the TMT joint in any direction?

    <p>Type A</p> Signup and view all the answers

    How are Lisfranc injuries categorized according to Nunley and Vertullo?

    <p>In three stages: I, II, and III</p> Signup and view all the answers

    What kind of traction is observed in a Stage I Lisfranc injury?

    <p>Low-grade sprain with normal imaging</p> Signup and view all the answers

    Which stage of injury is described as having complete disruption of the Lisfranc ligament complex?

    <p>Stage III</p> Signup and view all the answers

    Which structure is crucial for maintaining coronal plane stability in the TMT joint complex?

    <p>Second metatarsal</p> Signup and view all the answers

    Which column of the midfoot is characterized as the least mobile?

    <p>Medial column</p> Signup and view all the answers

    What configuration of the second metatarsal base aids in resisting shear forces?

    <p>Mortise configuration</p> Signup and view all the answers

    Which aspect of the Lisfranc joint contributes to its importance during a normal gait pattern?

    <p>Transition from midfoot to forefoot</p> Signup and view all the answers

    Which metatarsal column is described as the most mobile?

    <p>Lateral column</p> Signup and view all the answers

    What is the primary role of the Lisfranc joint within the foot?

    <p>Transition between midfoot and forefoot</p> Signup and view all the answers

    Which of the following structures is not part of the Lisfranc joint complex?

    <p>Fibula</p> Signup and view all the answers

    What characteristic feature of the TMT articulations allows for transition in the transverse plane?

    <p>Recessed metatarsal bases</p> Signup and view all the answers

    What is an indication for surgical intervention in open injuries?

    <p>Compromised distal perfusion</p> Signup and view all the answers

    What is the maximum acceptable gap between the medial cuneiform and second metatarsal in a normal alignment?

    <p>2 mm</p> Signup and view all the answers

    Which of the following pairs of structures should align on the AP view to indicate normal alignment?

    <p>Second metatarsal and middle cuneiform</p> Signup and view all the answers

    What is a commonly missed injury of the midfoot?

    <p>Lisfranc fracture dislocation</p> Signup and view all the answers

    A systematic review found there are no significant developments in the treatment of Lisfranc injuries.

    <p>False</p> Signup and view all the answers

    Which imaging technique is emphasized for evaluating the Lisfranc ligament in cadaveric studies?

    <p>MRI</p> Signup and view all the answers

    The piano key test is a clinical sign for identifying subtle __________ pathology.

    <p>tarsometatarsal</p> Signup and view all the answers

    Match the authors with their focus on Lisfranc injuries:

    <p>Myerson MS = Outcomes after open reduction and internal fixation Hatem SF = Imaging of midfoot injuries Lau S = Clinical sign for identifying injuries Stavlas P = Systematic review of fracture dislocations</p> Signup and view all the answers

    Which study analyzed the tarsometatarsal joint injuries specifically in athletes?

    <p>Panchbhavi VK et al.</p> Signup and view all the answers

    CT imaging is preferred over MRI for direct visualization of soft tissues.

    <p>False</p> Signup and view all the answers

    What common sign can aid in diagnosing occult Lisfranc injuries?

    <p>Plantar ecchymosis sign</p> Signup and view all the answers

    What radiographic finding indicates a Lisfranc injury between the first and second metatarsal bases?

    <p>Widening of greater than 1 mm</p> Signup and view all the answers

    Fracture fragments associated with Lisfranc injuries typically have regular margins and well-defined cortices.

    <p>False</p> Signup and view all the answers

    What is required to restore length and aid in reduction of multiple columns in Lisfranc injuries?

    <p>Operative fixation</p> Signup and view all the answers

    On lateral weight-bearing radiographs, a finding indicative of a Lisfranc injury is reduced distance between the plantar ___ and the metatarsals.

    <p>fascia</p> Signup and view all the answers

    Match the following findings with their related measurement indicative of a Lisfranc injury:

    <p>Widening between first and second metatarsal bases = &gt; 1 mm Widening between medial cuneiform and second metatarsal base = &gt; 2 mm Malalignment of longitudinal line = Any degree of malalignment</p> Signup and view all the answers

    Which of the following is a radiographic feature associated with Lisfranc injuries on oblique views?

    <p>Alignment of C3-M3</p> Signup and view all the answers

    The os intermetatarseum should always be treated as a fracture fragment in Lisfranc injuries.

    <p>False</p> Signup and view all the answers

    What should be observed between the medial cuneiform and second metatarsal base to indicate a possible Lisfranc injury?

    <p>Widening greater than 2 mm</p> Signup and view all the answers

    Which radiographic finding indicates a Lisfranc injury on the anteroposterior view?

    <blockquote> <p>1 mm of widening of M1-M2</p> </blockquote> Signup and view all the answers

    A talometatarsal angle greater than 15 degrees is a normal finding.

    <p>False</p> Signup and view all the answers

    What is a common risk associated with K-wire fixation?

    <p>Pin migration</p> Signup and view all the answers

    What is the most common finding in Lisfranc injuries according to the information provided?

    <p>lateral step-off at the medial margin of the second TMT joint</p> Signup and view all the answers

    The plantar cortex of C1 should project _ to the plantar cortex of M5.

    <p>dorsal</p> Signup and view all the answers

    Dislocations should always be reduced using open methods only.

    <p>False</p> Signup and view all the answers

    Match the findings to their descriptions for Lisfranc injuries:

    <p>Dorsal subluxations = Associated with TMT joint injuries Widening of C1-M2 = Indicates instability between cuneiforms and metatarsals Lateral step-off = Common in Lisfranc injury radiographs Bone fragment at C1-M2 = Suggests possible fracture involvement</p> Signup and view all the answers

    What condition should dictate the timing of surgery for closed injuries?

    <p>Resolution of swelling</p> Signup and view all the answers

    In open injuries, impending compartment syndrome and a threatened soft tissue envelope are considered ________ emergencies.

    <p>surgical</p> Signup and view all the answers

    What angle between the two black lines is considered normal?

    <p>&lt; 10 degrees</p> Signup and view all the answers

    Match the following factors with their significance in surgery timing:

    <p>Swelling resolution = Guides timing for closed injuries Pin migration = Complication of K-wire fixation Medial column fixation = Surgical procedure order Soft tissue envelope = Indicates need for surgery</p> Signup and view all the answers

    The dorsal margins of the TMT joints should show a step-off on a weight-bearing lateral radiograph.

    <p>False</p> Signup and view all the answers

    What is indicated by a talometatarsal angle greater than 15 degrees?

    <p>abnormal alignment or injury</p> Signup and view all the answers

    What is the first column to be fixed during surgery according to the protocol?

    <p>Medial column</p> Signup and view all the answers

    Suture button devices have not been examined for their effectiveness in recent studies.

    <p>False</p> Signup and view all the answers

    What complication is associated with K-wire fixation in surgical procedures?

    <p>Pin site infection</p> Signup and view all the answers

    What is indicated by stage I of the Lisfranc injury classification?

    <p>Low-grade sprain of the Lisfranc ligament complex</p> Signup and view all the answers

    Stage II Lisfranc injury is characterized by 1-mm to 5-mm diastasis between metatarsals.

    <p>True</p> Signup and view all the answers

    What is a common clinical finding in high-energy Lisfranc injuries?

    <p>Severe midfoot swelling and deformity</p> Signup and view all the answers

    Stage III Lisfranc injury results from __________ of the Lisfranc ligament complex.

    <p>complete disruption</p> Signup and view all the answers

    Match the following stages of Lisfranc injuries with their descriptions:

    <p>Stage I = Low-grade sprain of the Lisfranc ligament complex Stage II = Diastasis between metatarsals Stage III = Complete disruption of the Lisfranc ligament complex</p> Signup and view all the answers

    What complication should be considered in the event of severe pain and swelling following a Lisfranc injury?

    <p>Compartment syndrome</p> Signup and view all the answers

    Plain films will always show abnormal findings in Stage I Lisfranc injuries.

    <p>False</p> Signup and view all the answers

    Who combined clinical, radiographic, and bone scintigraphy findings into a classification system for Lisfranc injuries?

    <p>Nunley and Vertullo</p> Signup and view all the answers

    Which component of the Lisfranc ligament is represented by thick arrows in short-axis T2-weighted FS images?

    <p>Interosseous component</p> Signup and view all the answers

    The initial imaging evaluation for suspected Lisfranc injury should consist of weight-bearing radiographs.

    <p>False</p> Signup and view all the answers

    What imaging technique is commonly used to assess concomitant injuries in patients with high-energy Lisfranc injuries?

    <p>Advanced imaging</p> Signup and view all the answers

    The __________ component of the Lisfranc ligament is represented by graded gray bands in the anatomic diagram.

    <p>plantar</p> Signup and view all the answers

    Match the following components of Lisfranc ligaments with their descriptions:

    <p>Interosseous component = Main stabilizer of the tarsometatarsal (TMT) joint Dorsal component = Lies on the top side of the midfoot Plantar component = Supports the bottom of the foot C1 = First cuneiform bone</p> Signup and view all the answers

    Which finding in an imaging study suggests a stable midfoot condition?

    <p>Normal appearance of plantar ligament</p> Signup and view all the answers

    Patients with open Lisfranc injuries require urgent débridement and stabilization.

    <p>True</p> Signup and view all the answers

    What is assessed using axial T2-weighted FS MR images to determine the extent of Lisfranc injuries?

    <p>Lisfranc ligament integrity</p> Signup and view all the answers

    Which type of trauma is associated most commonly with homolateral injuries?

    <p>Motor vehicle accidents</p> Signup and view all the answers

    Isolated injuries are the most common type of Lisfranc injury.

    <p>False</p> Signup and view all the answers

    What classification system divides Lisfranc fracture-dislocations into types A, B, and C?

    <p>Myerson classification</p> Signup and view all the answers

    Stage III of the Lisfranc injury indicates disruption of the ______ and ______ ligaments.

    <p>dorsal Lisfranc, plantar</p> Signup and view all the answers

    Match the following Lisfranc injury types with their corresponding descriptions:

    <p>Type A = Total incongruity of TMT joints Type B = Partial incongruity with metatarsal displacement Stage I = Conservative treatment indicated Stage III = Surgical treatment required</p> Signup and view all the answers

    What is a common treatment approach for Stage I Lisfranc injuries?

    <p>Conservative treatment</p> Signup and view all the answers

    Divergent injuries involve separation of metatarsals in the same direction.

    <p>False</p> Signup and view all the answers

    What does type B injury encompass regarding metatarsal displacement?

    <p>1 or more metatarsals being displaced with partial incongruity</p> Signup and view all the answers

    What imaging technique is particularly valuable for evaluating ligament complexes due to its ability to provide thin slices for multiplanar reformatted images?

    <p>Fast spin-echo volumetric SPACE</p> Signup and view all the answers

    CT is not useful for evaluating arthritis and bony deformities.

    <p>False</p> Signup and view all the answers

    What kind of injuries is MR imaging primarily important for diagnosing and managing?

    <p>low-energy Lisfranc injuries</p> Signup and view all the answers

    The imaging sequence known as ______ can help identify marrow and soft tissue signal abnormalities.

    <p>T2-weighted or proton-density fat saturation</p> Signup and view all the answers

    Match the following imaging techniques with their primary focus:

    <p>CT = Evaluating arthritis and bony deformities MR Imaging = Diagnosing low-energy Lisfranc injuries Fast spin-echo volumetric SPACE = Assessing ligament complex T2-weighted images = Identifying marrow and soft tissue signal abnormalities</p> Signup and view all the answers

    What percentage more metatarsal fractures were seen at CT compared to radiography according to the study?

    <p>50%</p> Signup and view all the answers

    Stress radiographs are typically performed on patients with stable Lisfranc injuries.

    <p>False</p> Signup and view all the answers

    What is considered abnormal in diastasis between the first and second metatarsal bases?

    <p>More than 2 mm</p> Signup and view all the answers

    Computed tomography is recommended when radiographic findings are _______.

    <p>normal or equivocal</p> Signup and view all the answers

    Match the following findings with their corresponding imaging modality:

    <p>Unobscured osseous anatomy = CT Reduced distance between metatarsals = NWB radiograph Dynamic instability = Stress radiograph Normal tarsal alignment = MRI</p> Signup and view all the answers

    What type of surgical fixation method was evaluated by Brin et al. for Lisfranc injury repair?

    <p>TightRope device</p> Signup and view all the answers

    Which of the following injuries may indicate the need for stress radiographs?

    <p>Unstable or suspected Lisfranc injuries</p> Signup and view all the answers

    The study by Kuo et al. focused on the outcomes of non-surgical treatment for Lisfranc joint injuries.

    <p>False</p> Signup and view all the answers

    CT imaging can demonstrate subtle fractures that are not easily identified by radiography.

    <p>True</p> Signup and view all the answers

    What is the recommended approach when high clinical suspicion of Lisfranc injury exists, but radiographs show normal findings?

    <p>Obtain stress radiographs</p> Signup and view all the answers

    Which anatomical structure is primarily associated with midfoot instability in subtle Lisfranc injuries?

    <p>Lisfranc ligament</p> Signup and view all the answers

    A biomechanical comparison mentioned in the research focused on injuries in the __________ joint.

    <p>Lisfranc</p> Signup and view all the answers

    Which imaging technique is primarily recommended for evaluating soft tissue structures?

    <p>MRI</p> Signup and view all the answers

    Match the research studies with their focus area:

    <p>Delfaut et al. = MR features in asymptomatic patients Raikin et al. = Midfoot instability prediction Pelt et al. = Biomechanics of suture devices Alberta et al. = Comparison of fixation methods for Lisfranc injuries</p> Signup and view all the answers

    Patients with stable Lisfranc injuries are often recommended to receive initial protection for the soft tissues.

    <p>True</p> Signup and view all the answers

    What is a disadvantage of transarticular screw fixation in Lisfranc injuries?

    <p>Requires removal of screws</p> Signup and view all the answers

    Dorsal plating minimizes additional soft tissue damage compared to transarticular screw placement.

    <p>True</p> Signup and view all the answers

    What type of Lisfranc injury was demonstrated in the initial radiograph?

    <p>Meyerson Type C2 total divergent type Lisfranc fracture-dislocation</p> Signup and view all the answers

    Primary arthrodesis is rarely performed in ___ due to its complications.

    <p>athletes</p> Signup and view all the answers

    Match the surgical treatment options to their advantages or characteristics:

    <p>Transarticular screws = Can lead to articular damage Dorsal plating = Reduces joint displacement Primary arthrodesis = May require bone grafting K-wire fixation = Less invasive technique</p> Signup and view all the answers

    What may be an alternative treatment for severely comminuted intra-articular fractures?

    <p>Primary arthrodesis</p> Signup and view all the answers

    Dorsal plating can be inserted with minimal dissection.

    <p>False</p> Signup and view all the answers

    What is a key function of K-wire fixation in Lisfranc injuries?

    <p>Stabilizing the medial and middle columns</p> Signup and view all the answers

    Which components are part of the Lisfranc ligaments as seen in imaging?

    <p>All of the above</p> Signup and view all the answers

    High-energy injuries such as crush injuries are straightforward to diagnose.

    <p>True</p> Signup and view all the answers

    What is the recommended management for open injuries of the Lisfranc injury?

    <p>Urgent irrigation and debridement</p> Signup and view all the answers

    The Lisfranc ligament is visualized as a thick band running from C1 to M2 on an axial T2-weighted FS MR image, indicated by _____ in the imaging.

    <p>arrows</p> Signup and view all the answers

    Match the following terms with their descriptions:

    <p>NWB radiographs = Used for initial imaging evaluation Fat-saturated imaging = Enhances visibility of soft tissue Bone marrow edema = Indicates potential injury and inflammation Lisfranc ligament = Connects the first cuneiform to the second metatarsal</p> Signup and view all the answers

    Which of the following factors can compromise the final outcome of Lisfranc injuries?

    <p>All of the above</p> Signup and view all the answers

    Compartment syndrome evaluations should not be conducted in patients with high-energy injuries.

    <p>False</p> Signup and view all the answers

    What imaging technique is typically the first step in evaluating a suspected Lisfranc injury?

    <p>NWB radiographs</p> Signup and view all the answers

    What is a limitation of MR imaging compared to CT in the detection of fractures?

    <p>MR imaging may misdiagnose small avulsion fractures as bone bruise.</p> Signup and view all the answers

    What imaging technique is particularly beneficial for surgical planning in patients with complex fractures after high-energy trauma?

    <p>Three-dimensional (3D) volume rendering (VR) images</p> Signup and view all the answers

    What is the recommended imaging direction for the CT beam when assessing the injured foot?

    <p>Oriented along the metatarsals</p> Signup and view all the answers

    What could be inferred if tarsometatarsal malalignment is detected on MR imaging without accompanying abnormalities?

    <p>The significance of the malalignment is uncertain.</p> Signup and view all the answers

    What is an important factor to consider when diagnosing serious midfoot injuries?

    <p>Identification of fleck signs on plain radiographs</p> Signup and view all the answers

    Which imaging modality is generally superior in visualizing soft tissue structures?

    <p>MR imaging</p> Signup and view all the answers

    In terms of imaging protocols, what is critical for evaluating the ligament complex in the injured foot?

    <p>Acquiring images with a small field of view</p> Signup and view all the answers

    What type of fractures may be more effectively detected using multiplanar reformatted CT data?

    <p>Complex fractures with subtleties</p> Signup and view all the answers

    What is a common characteristic of indirect injuries compared to direct injuries in the context of foot injuries?

    <p>They can occur without a significant force applied.</p> Signup and view all the answers

    Which classification describes Lisfranc fracture-dislocations based on the direction of metatarsal displacement?

    <p>Homolateral, isolated, and divergent.</p> Signup and view all the answers

    What is a typical outcome associated with low-energy Lisfranc injuries?

    <p>They may easily go undiagnosed due to subtle findings.</p> Signup and view all the answers

    Which statement accurately describes the use of existing classification systems for managing injuries?

    <p>They do not assist in predicting outcomes for many injuries.</p> Signup and view all the answers

    What injury mechanism typically leads to the dislocation of metatarsals in Lisfranc injuries?

    <p>Direct blunt force from above.</p> Signup and view all the answers

    In the classification of athletic midfoot injuries by Nunley and Vertullo, which factor is primarily considered?

    <p>Clinical findings and radiographs.</p> Signup and view all the answers

    Which type of ligament is classified as a plantar ligament in the context of Lisfranc injuries?

    <p>Plantar Lisfranc ligament.</p> Signup and view all the answers

    What challenge is most commonly associated with diagnosing low-energy Lisfranc injuries?

    <p>Overlapping symptoms with sprains.</p> Signup and view all the answers

    What is the primary treatment for patients with Nunley and Vertullo stage II injuries?

    <p>Surgical intervention with open reduction and internal fixation</p> Signup and view all the answers

    In the management of Lisfranc injuries, what is the recommended imaging modality for further assessment when initial radiographs show normal findings but there is still a high clinical suspicion?

    <p>MR imaging</p> Signup and view all the answers

    What is the recommended treatment for stable Lisfranc injuries that are nondisplaced?

    <p>Protected weight-bearing with a controlled ankle motion walking boot</p> Signup and view all the answers

    What is often crucial to repeat two weeks after the initial presentation of a Lisfranc injury?

    <p>Weight-bearing radiographs to rule out occult instability</p> Signup and view all the answers

    For which of the following situations is nonoperative treatment likely indicated?

    <p>Patients with insensate feet and inflammatory arthritis</p> Signup and view all the answers

    Which stage of Lisfranc injury does not require surgical intervention and can be treated conservatively?

    <p>Nunley and Vertullo stage I</p> Signup and view all the answers

    What imaging approach is recommended for evaluating subtle malalignment in weight-bearing radiographs of the Lisfranc joint?

    <p>Detailed scrutiny of weight-bearing radiographs</p> Signup and view all the answers

    What might indicate a need for surgical stabilization in cases of Lisfranc injury despite initial imaging showing no significant findings?

    <p>Presence of high clinical suspicion for injury</p> Signup and view all the answers

    Which imaging technique offers the advantage of optimized contrasts when evaluating the Lisfranc joint?

    <p>3D-SPACE sequence</p> Signup and view all the answers

    What is the primary focus of the research conducted by Raikin et al. regarding Lisfranc injuries?

    <p>Prediction of midfoot instability in subtle Lisfranc injuries</p> Signup and view all the answers

    In Kuo et al.'s study, what surgical outcome was evaluated following open reduction and internal fixation of Lisfranc joint injuries?

    <p>Overall postoperative functional outcomes</p> Signup and view all the answers

    What technique was specifically used in a biomechanical analysis of Lisfranc injury fixation devices in the study by Pelt et al.?

    <p>Tensioned suture device</p> Signup and view all the answers

    Which research specifically discusses a biomechanical comparison of methods for treating ligamentous Lisfranc injuries?

    <p>The study by Alberta FG et al.</p> Signup and view all the answers

    What is the relevance of the TightRope device in the context of Lisfranc injury repair as mentioned by Brin et al.?

    <p>It serves as a fixation option for ligamentous injuries.</p> Signup and view all the answers

    Which part of the Lisfranc joint injuries does the study by Ly et al. emphasize primarily?

    <p>The management of primarily ligamentous injuries</p> Signup and view all the answers

    What aspect of MRI utilization is evaluated in the study by Ulbrich et al. regarding the Lisfranc ligament?

    <p>3D-SPACE MRI versus axial imaging techniques</p> Signup and view all the answers

    What is a common feature associated with complete tears of the ligament in Lisfranc injuries?

    <p>Displacement of the medial cuneiform and second metatarsal base</p> Signup and view all the answers

    What challenge arises in diagnosing Lisfranc injuries during the chronic phase?

    <p>Thickening and signal heterogeneity of the injured ligament</p> Signup and view all the answers

    Which ligament was noted to be the most commonly injured in American football players with suspected Lisfranc injuries?

    <p>Plantar Lisfranc ligament</p> Signup and view all the answers

    What type of imaging is especially useful for assessing associated injuries with Lisfranc injuries?

    <p>MRI</p> Signup and view all the answers

    In assessing Lisfranc injuries, which other soft tissue injuries might be encountered?

    <p>Anterior tibialis tendon injuries</p> Signup and view all the answers

    What is a noted imaging finding related to the quality of the injured ligament in the chronic phase?

    <p>Signal heterogeneity</p> Signup and view all the answers

    What type of injury is primarily assessed when examining for diastasis at the Lisfranc joint?

    <p>Fracture-dislocation of the metatarsals</p> Signup and view all the answers

    What type of dislocation is typically noted in Lisfranc injuries involving the metatarsals?

    <p>Lateral dislocation of all metatarsals</p> Signup and view all the answers

    Which factor is associated with the anatomical structure of the Lisfranc joint complex?

    <p>The strength of the plantar ligaments compared to dorsal ligaments</p> Signup and view all the answers

    What imaging finding is frequently analyzed for diagnosing Lisfranc joint injuries?

    <p>Malalignment of tarsometatarsal joints</p> Signup and view all the answers

    In the context of Lisfranc injuries, what does the term 'diastasis' refer to?

    <p>Separation between tarsal bones</p> Signup and view all the answers

    What is a common complication associated with untreated Lisfranc fractures?

    <p>Development of severe foot deformities</p> Signup and view all the answers

    Which publication investigates the outcomes of surgical approaches for Lisfranc injuries?

    <p>Foot Ankle Int 1990</p> Signup and view all the answers

    Which imaging technique is noted for its effectiveness in visualizing complications of Lisfranc injuries?

    <p>Computed tomography (CT)</p> Signup and view all the answers

    What anatomical feature of the Lisfranc joint makes dating ligamentous injuries challenging?

    <p>Complex intertarsal relationships</p> Signup and view all the answers

    Which clinical sign is commonly used to assess subtle Lisfranc injuries in athletes?

    <p>Piano key test</p> Signup and view all the answers

    Study Notes

    Lisfranc Injury Current Concepts

    • Lisfranc injury involves the tarsometatarsal (TMT) joints of the midfoot, ranging from sprains to fractures to dislocations.
    • Prompt diagnosis and appropriate treatment preventing osteoarthritis and deformity are key.
    • Radiographic evaluation requires a thorough assessment of subtle fractures and misalignment in all views.
    • Computed tomography (CT) and magnetic resonance imaging (MRI) are crucial for diagnosing low-energy injuries.

    Introduction

    • Lisfranc injuries are uncommon, accounting for ~0.2% of all fractures.
    • They frequently coexist with other tarsal or metatarsal fractures.
    • US incidence is ~1 per 55,000 annually, potentially underestimated, with ~1/3 missed initially.
    • High-energy injuries are typically secondary to traumatic events (e.g., motor vehicle accidents, falls) while low-energy injuries often result from athletic trauma or missteps.
    • Motor vehicle accidents are the most common mechanism (~40-45%), followed by low-energy mechanisms (~30%).
    • Lisfranc injuries account for >15% of athletic injuries, and are increasing in prevalence.
    • Injuries occur most frequently in the third decade of life.
    • Males are more prone to Lisfranc injuries due to greater participation in high-speed activities.
    • Lisfranc injuries can occur as part of neuropathic arthropathy.
    • Lisfranc injuries occur in 4% of football players and 29.2% of offensive linemen per year.
    • The "bunk bed" fracture is the pediatric equivalent of the TMT fracture-dislocation in adults.

    Anatomy

    • The midfoot consists of 5 bones (3 cuneiforms, cuboid, navicular).
    • The Lisfranc joint encompasses the articulations between the cuneiforms and cuboid, and the 5 metatarsals.
    • The second metatarsal plays a keystone role, maintaining coronal plane stability.
    • The TMT joints transition from medial to lateral in the transverse plane.
    • The anatomical configuration is critical for mobility during weight-bearing activities.
    • The midfoot is categorized into three columns (medial, middle, lateral), each with variable degrees of mobility. The middle column is the most rigid.

    Ligaments

    • The Lisfranc joint complex comprises the TMT articular surfaces, intermetatarsal and anterior intertarsal surfaces and reinforcing ligaments.
    • Dorsal, plantar, and interosseous ligaments are crucial structures for stability. The dorsal ligaments are generally more vulnerable than the plantar ones.
    • The Lisfranc ligament (medial longitudinal ligament) is the largest TMT ligament.
    • The plantar ligaments are generally stronger than the dorsal ligaments.

    Mechanism of Injury

    • Lisfranc injuries can result from direct or indirect forces.
    • High-energy direct injuries are typically associated with motor vehicle accidents or falls. These can lead to plantar or dorsal dislocation of metatarsals, and often coincide with other tarsal or metatarsal fractures.
    • Low-energy indirect injuries, often seen in athletics, are due to excessive force applied during plantar flexion resulting from a fall, misstep, or during athletic activities as demonstrated during certain sports (e.g., football, gymnastic).
    • Indirect injuries can result from falls, sports activities, missteps, or even a misstep, or while riding a horse (during a fall).

    Classifications

    • Several classification systems exist, with the Myerson classification being a commonly used approach. Myerson categorizes injuries into types A, B, and C, based on degree of displacement:

      • Type A: Total incongruity
      • Type B: Partial incongruity (B1- medial, B2-lateral)
      • Type C: Divergent displacement (C1-partial, C2-total)

    • The Quenu and Kuss classification system, while simpler, is also frequently used for practical purposes. This system classifies Lisfranc injuries by the direction of metatarsal displacement (homolateral, isolated, or divergent).

    • The Nunley and Vertullo classification system is directed towards athletic injuries, focusing on clinical, radiographic and bone scan findings. This system classifies the severity into Stages I, II, and III, according to the presence of diastasis and arch height loss.

    Diagnosis

    • Clinical findings include variable swelling and pain, particularly on palpation or manipulation of the TMT joints.
    • The "piano key test" is an important diagnostic maneuver.
    • Radiographic assessment requires anteroposterior, oblique, and lateral views (NWB and WB). Comparison views with the uninjured foot are crucial.
    • Computed tomography (CT), especially with multiplanar capabilities, offers added advantages for visualizing subtle fracture patterns and malalignment, and allows for visualization of unobscured osseous anatomy.
    • Magnetic resonance imaging (MRI) is helpful in diagnosing low-energy injuries, depicting marrow edema, ligament tears, and soft tissue abnormalities not clearly visible in radiographic views.

    Management

    • Management strategies are tailored based on injury severity and the presence of fractures or dislocations.
    • Stable injuries may be managed conservatively (e.g., immobilization).
    • Unstable injuries necessitate surgical intervention (ORIF), often with transarticular screws.
    • The timing of surgery depends on several factors including wound conditions and the status of surrounding tissues. Additional factors to consider are patient mobility needs and activities.
    • Goals of treatment include restoring the precise anatomical relationship and achieving a painless, stable foot. The key is to determine if the injury is stable or unstable (involving bone displacement or dislocation) to inform whether non-surgical or surgical treatment is appropriate.

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    Lisfranc Injury Current Concepts PDF

    Description

    Test your knowledge on the tarsometatarsal joint complex, including common imaging modalities and treatment options for injuries. This quiz covers anatomy, diagnosis, and the implications of tarsometatarsal injuries, providing insight into sports-related foot and ankle issues.

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