Fracture Dislocation Of The Midfoot (Lisfranc Injury)

A Lisfranc injury is a fracture and / or displacement of the midfoot, which destroys one or more tarsometatarsal joints. Diagnosis is made by radiography and CT often. The treatment requires referral to an orthopedic surgeon and usually open reduction and internal fixation or sometimes fusion of the midfoot.

A Lisfranc injury is a fracture and / or displacement of the midfoot, which destroys one or more tarsometatarsal joints. Diagnosis is made by radiography and CT often. The treatment requires referral to an orthopedic surgeon and usually open reduction and internal fixation or sometimes fusion of the midfoot.

(Lisfranc injury) A Lisfranc injury is a fracture and / or displacement of the midfoot, which destroys one or more tarsometatarsal joints. Diagnosis is made by radiography and CT often. The treatment requires referral to an orthopedic surgeon and usually open reduction and internal fixation or sometimes fusion of the midfoot. These injuries are common. The usual mechanism is a direct blow or indirect rotational force to a foot in plantar flexion (for example, the case of a foot in plantar flexion). The Lisfranc joint complex consists of five tarsometatarsal connecting the forefoot and midfoot. There are many ligaments in this complex The Lisfranc ligament itself is the band cuneiforme the base of the second metatarsal bone at Os I fixed. Complex Lisfranc injuries vary on the severity of charges to dislocation of one or more tarsometatarsal with or without fracture. When a fracture occurs, the second metatarsal is often involved. Lisfranc injuries often cause instability of the midfoot. Fracture at the base of II. Metatarsals with tarsometastarsaler Gelenkislokation The fracture of the 2nd metatarsal base can destroy one or more of tarsometatarsal joints. In this illustration, the second metatarsal displaces the third side by the fifth metatarsal. The severity varies. Some injuries cause only slight swelling and pain in the midfoot; Another cause severe soft tissue pain and swelling, deformity, a hematoma on the sole of the midfoot and sometimes paresthesia. The foot may appear shortened. Complications (. E.g osteoarthritis, compartment syndrome) can be severe and chronic disability is widespread. Diagnostic X-rays CT Occasionally anteroposterior are added lateral and oblique radiographs of the foot, but the findings can be subtle, leading to misdiagnosis. Up to 20% of these fractures are not recognized at the first presentation. X-rays may show cuneiforme only a fracture of the base of the II. Metatarsals or Absplitterungsfrakturen of Os, but it shows no damage to the tarsometatarsal joint which, however, should be suspected even if they can not be seen on X-rays. Normally coincides in this joint, the medial side of the cuneiform II directly to the medial side of the second metatarsal. Comparative views or CT may be necessary to identify a destruction of the joint. Tips and risks If the midfoot is extremely swollen and painful, check the radiograph closely to determine if the medial side of the cuneiform II coincides directly with the medial side of the second metatarsal. If a CT is not readily available, stress recordings can be used. X-rays are created during the foot is under stress (for example, is the patient on the foot). The patient’s body weight can cause an expansion of the gap between the first and second metatarsal, which substantially facilitates the diagnosis. However, CT is more sensitive than stress recordings and so is preferred in ambiguous cases. Therapy Orthopedic consultation Normally open reduction and internal fixation (ORIF) or sometimes fusion of the midfoot dislocations often reduce spontaneously. Nevertheless, as these injuries usually interfere with the foot function and cause residual pain and arthritis, patients should be immediately referred to an orthopedic specialist, usually for an operation. Typically, the definitive treatment ORIF or merger of the midfoot. After an ORIF, usually to confirm a correct reposition a CT is performed. If surgery is not deemed necessary, patients are sedated without weight load for ? 6 wk. Important points Lisfranc injuries include destruction ? 1 band that stabilizes the midfoot, and sometimes destruction of ? 1 tarsometatarsal joint. Complications (eg. As compartment syndrome, chronic pain, disability) can be severe. Since X-ray findings can be subtle, stress shots or CT may be required. Please transfer the patient to an orthopedic surgeon; usually ORIF or fusion of the metatarsal is needed.

Health Life Media Team

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