Lisfranc Injury Of The Foot: Diagnosis Is Often Overlooked :
Injury Lisfranc joint are rare, complex and often misdiagnosed. Typical signs and symptoms include pain, swelling and inability to bear weight. Clinically, the lesions vary from mild sprains to fracture-dislocation. On physical examination, the swelling is due mainly to the middle region of the foot. The pain is caused by palpation over the tarsal joints and the force applied to this area can cause pain or medial. Radiographs showing diastasis of the normal architecture confirm the presence of a severe sprain and disruption as possible. Negative x standard weight-bearing do not exclude a mild or moderate sprain . Reevaluation may be necessary if the pain and swelling continue for 10 days after injury. Proper treatment of mild to moderate Lisfranc injury improves the chances of successful healing and reduces the likelihood of complications.
Patients with fractures and fracture-dislocations should be referred for surgical treatment.
The Lisfranc joint, or tarsometatarsal articulation of the foot, is named after Jacques Lisfranc (1790-1847), a field surgeon in Napoleon's army. Lisfranc described an amputation performed through this joint because of gangrene that developed after an injury occurs when a soldier fell from a horse with his foot caught in stirrup.1, 2
It fractures dislocations of Lisfranc joint is a case for 55 000 people per year.2, 3, so that these injuries represent less than 1 percent of all fractures.2, 3 Up to 20 percent of Lisfranc joint injuries are missed on the first anteroposterior and oblique radiographs.2-4
Fracturedislocations Lisfranc joint sprains and can be caused by high energy forces in motor vehicle crashes, industrial accidents and falls from high places.1-3 Sometimes this damage is due to a less stressful as a fall twist. Since Lisfranc joint fracturedislocations and sprains carry a high risk of secondary chronic disability, the two doctors to maintain a high index of suspicion for these injuries in patients with foot injuries characterized by marked swelling, tenderness and tarsometatarsal joint inability to bear weight.
Explain The Problem :
A 20 year old man had an accident when he was thrown from a sled. His weight fell on his left foot which was bent under him. The day of the accident, had his foot examined in a hospital. Standard anteroposterior and lateral radiographs showed no fracture. The foot was placed in slight plantar flexion and immobilized with a plaster mou.
After three days, the patient was reassessed at a health clinic for students. His left foot remained swollen and bruising was noted laterally. Weight-bearing was intolerable. The soft cast was removed and an elastic wrap applied.A was 20 years old man had an accident when he was thrown from a sled. His weight fell on his left foot which was bent under him. The day of the accident, had his foot examined in a hospital. Standard anteroposterior and lateral radiographs showed no fracture. The foot was placed in slight plantar flexion and immobilized with a plaster mou.After three days, the patient was reassessed at a health clinic for students. His left foot remained swollen and bruising was noted laterally. Weight-bearing was intolerable. The soft cast was removed and an elastic wrap was applied.
Definitions And Anatomy :
To reduce confusion, some investigators5 have suggested that the term "Lisfranc joint complex" should be used to refer to the tarsometatarsal joints, and that the term "Lisfranc's joint" should be applied to the articulation of the medial first metatarsal and the second with medial (first) and middle (second) cuneiform.. Lisfranc ligament is a band of collagen tissue that extends from the plantar articulation of the medial cuneiform and second metatarsal base.4, 6.7 Although the transverse ligaments connect the base of the four side-Hock, is the transverse ligament between the bases and the first second metatarsal. Nerves and ligaments of the spine have little support from the posterior surface of the Lisfranc joint.3, 6.7 bone architecture of this policy, in particular "keystone" of the second metatarsal cuneiform joint, is the focal point that supports' entire tarsometatarsal articulation.
This anatomy establishes a "weak link" that, with stress, are prone to injury.The complexity of the complex anatomy of the Lisfranc joint leads to multiple injuries patterns.6 distortions are the most common injuries, with a distortion metatarsal is the least serious distortion injury.8 severity usually depends on the energy consumption of an accident. Most tarsometatarsal ligament injuries are grade I (joint pain, swelling and instability minimum) or class II (increased pain and swelling, along with mild laxity but no instability). The most serious distortion of grade III represents complete destruction of the ligaments, and may represent different fracture classifications dislocation.9 more true fracture-dislocations are used, but do not predict prognosis.4 10, 6
Mechanisms Of Injury :
Lisfranc joint injuries may result from complex trauma.3 direct or indirect, 11 direct trauma occurs when an external force strikes the foot. With indirect trauma, force is transmitted to the stationary foot so that the weight of the body becomes a deforming force torque, or rotation compression.2, 5.7
Functionally, the foot is divided into three sections: the legs that absorb shock during ambulation, the midfoot, which can translate the power and ensures the stability of rotation of the foot and the forefoot, which contributes to the "toe off" phase of the process. The Lisfranc joint promotes energy dissipation by allowing force to be transferred between the midfoot and forefoot.
Because of its reduced mobility, the Lisfranc joint of a stable axis of rotation, and is also the cornerstone of plantar flexion and dorsiflexion. The horizontal axis on which the plantar flexion and dorsiflexion occur, goes straight through the junction of the metaphysis and diaphysis in the bottom of the second metatarsal. Thus, the lack of back support and the immobility of the second metatarsal, placing the foot in extreme plantar flexion with an axial load can cause a stress sufficient to cause dorsal displacement of the second metatarsal base .
The Surgical Treatment :
If surgical repair is necessary, it should occur in 12 to 24 hours after the injury. Alternately operation carried out after seven to 10 days to reduce the swelling.4, 5.15
While some orthopedists3, 4.6 prefer the closed percutaneous K-son (the son of Kirshner), others5, 11 indicate that this method does not hold anatomic reduction and fixation. An alternative method is the use of open reduction and internal fixation with AO screw fixation (ie, meets Arbeitsgemeinschaft für Osteosynthesefragen standards). An open surgical field facilitates the removal of fragments or soft tissue may prevent dislocation.3 reduction, 5.6
When an open reduction and internal fixation, most orthopedists, at the foot of the cast stopped on December 8 weeks with a small (toe-touch) weight bearing.3, 5.11 Noncasted, size is not usually allowed until the screw or AO similar device 12 is removed from eight weeks. 3, 5 for three months throws removal, the patient must wear a protective boot cast rehabilitation.
Moses Cone family residing practice residency program, Greensboro, NC Dr. Burroughs graduated from the University of North Carolina at Chapel Hill School of Medicine.
CURTIS D. Reimer, MD,
is a family physician with Family Practice Medical Building, Hastings, Neb. Dr. Reimer earned a medical degree from the University of Nebraska College of Medicine, Omaha, and completed the friendship in sports medicine to primary care estate Moses Cone Family Practice. He also added a certificate of competency of Sports Medicine.
Karl B. Fields, MD,
Residence is a sports medicine fellowship director and director Moses Cone Family Practice Residency. It 'also Adjunct Professor and Director of the Department of Family Medicine attached to the University of North Carolina at Chapel Hill School of Medicine. After receiving a medical degree from the University of Kentucky College of Medicine, Lexington, Dr. Fields completed a residency in family medicine in Charlotte (NC) Memorial Hospital and fellowship for the academic development of the University of North Carolina at Chapel Hill. He has added a certificate of competency of Sports Medicine.
Injury Lisfranc joint are rare, complex and often misdiagnosed. Typical signs and symptoms include pain, swelling and inability to bear weight. Clinically, the lesions vary from mild sprains to fracture-dislocation. On physical examination, the swelling is due mainly to the middle region of the foot. The pain is caused by palpation over the tarsal joints and the force applied to this area can cause pain or medial. Radiographs showing diastasis of the normal architecture confirm the presence of a severe sprain and disruption as possible. Negative x standard weight-bearing do not exclude a mild or moderate sprain . Reevaluation may be necessary if the pain and swelling continue for 10 days after injury. Proper treatment of mild to moderate Lisfranc injury improves the chances of successful healing and reduces the likelihood of complications.
Patients with fractures and fracture-dislocations should be referred for surgical treatment.
 |
| Lisfranc Injury Symptoms |
It fractures dislocations of Lisfranc joint is a case for 55 000 people per year.2, 3, so that these injuries represent less than 1 percent of all fractures.2, 3 Up to 20 percent of Lisfranc joint injuries are missed on the first anteroposterior and oblique radiographs.2-4
Fracturedislocations Lisfranc joint sprains and can be caused by high energy forces in motor vehicle crashes, industrial accidents and falls from high places.1-3 Sometimes this damage is due to a less stressful as a fall twist. Since Lisfranc joint fracturedislocations and sprains carry a high risk of secondary chronic disability, the two doctors to maintain a high index of suspicion for these injuries in patients with foot injuries characterized by marked swelling, tenderness and tarsometatarsal joint inability to bear weight.
A 20 year old man had an accident when he was thrown from a sled. His weight fell on his left foot which was bent under him. The day of the accident, had his foot examined in a hospital. Standard anteroposterior and lateral radiographs showed no fracture. The foot was placed in slight plantar flexion and immobilized with a plaster mou.
After three days, the patient was reassessed at a health clinic for students. His left foot remained swollen and bruising was noted laterally. Weight-bearing was intolerable. The soft cast was removed and an elastic wrap applied.A was 20 years old man had an accident when he was thrown from a sled. His weight fell on his left foot which was bent under him. The day of the accident, had his foot examined in a hospital. Standard anteroposterior and lateral radiographs showed no fracture. The foot was placed in slight plantar flexion and immobilized with a plaster mou.After three days, the patient was reassessed at a health clinic for students. His left foot remained swollen and bruising was noted laterally. Weight-bearing was intolerable. The soft cast was removed and an elastic wrap was applied.
 |
| Lisfranc Injury Symptoms |
To reduce confusion, some investigators5 have suggested that the term "Lisfranc joint complex" should be used to refer to the tarsometatarsal joints, and that the term "Lisfranc's joint" should be applied to the articulation of the medial first metatarsal and the second with medial (first) and middle (second) cuneiform.. Lisfranc ligament is a band of collagen tissue that extends from the plantar articulation of the medial cuneiform and second metatarsal base.4, 6.7 Although the transverse ligaments connect the base of the four side-Hock, is the transverse ligament between the bases and the first second metatarsal. Nerves and ligaments of the spine have little support from the posterior surface of the Lisfranc joint.3, 6.7 bone architecture of this policy, in particular "keystone" of the second metatarsal cuneiform joint, is the focal point that supports' entire tarsometatarsal articulation.
This anatomy establishes a "weak link" that, with stress, are prone to injury.The complexity of the complex anatomy of the Lisfranc joint leads to multiple injuries patterns.6 distortions are the most common injuries, with a distortion metatarsal is the least serious distortion injury.8 severity usually depends on the energy consumption of an accident. Most tarsometatarsal ligament injuries are grade I (joint pain, swelling and instability minimum) or class II (increased pain and swelling, along with mild laxity but no instability). The most serious distortion of grade III represents complete destruction of the ligaments, and may represent different fracture classifications dislocation.9 more true fracture-dislocations are used, but do not predict prognosis.4 10, 6
Mechanisms Of Injury :
Lisfranc joint injuries may result from complex trauma.3 direct or indirect, 11 direct trauma occurs when an external force strikes the foot. With indirect trauma, force is transmitted to the stationary foot so that the weight of the body becomes a deforming force torque, or rotation compression.2, 5.7
Functionally, the foot is divided into three sections: the legs that absorb shock during ambulation, the midfoot, which can translate the power and ensures the stability of rotation of the foot and the forefoot, which contributes to the "toe off" phase of the process. The Lisfranc joint promotes energy dissipation by allowing force to be transferred between the midfoot and forefoot.
Because of its reduced mobility, the Lisfranc joint of a stable axis of rotation, and is also the cornerstone of plantar flexion and dorsiflexion. The horizontal axis on which the plantar flexion and dorsiflexion occur, goes straight through the junction of the metaphysis and diaphysis in the bottom of the second metatarsal. Thus, the lack of back support and the immobility of the second metatarsal, placing the foot in extreme plantar flexion with an axial load can cause a stress sufficient to cause dorsal displacement of the second metatarsal base .
 |
| Lisfranc Injury Symptoms |
If surgical repair is necessary, it should occur in 12 to 24 hours after the injury. Alternately operation carried out after seven to 10 days to reduce the swelling.4, 5.15
While some orthopedists3, 4.6 prefer the closed percutaneous K-son (the son of Kirshner), others5, 11 indicate that this method does not hold anatomic reduction and fixation. An alternative method is the use of open reduction and internal fixation with AO screw fixation (ie, meets Arbeitsgemeinschaft für Osteosynthesefragen standards). An open surgical field facilitates the removal of fragments or soft tissue may prevent dislocation.3 reduction, 5.6
When an open reduction and internal fixation, most orthopedists, at the foot of the cast stopped on December 8 weeks with a small (toe-touch) weight bearing.3, 5.11 Noncasted, size is not usually allowed until the screw or AO similar device 12 is removed from eight weeks. 3, 5 for three months throws removal, the patient must wear a protective boot cast rehabilitation.
Authors
Kevin E. BURROUGHS, MD,
Moses Cone family residing practice residency program, Greensboro, NC Dr. Burroughs graduated from the University of North Carolina at Chapel Hill School of Medicine.
CURTIS D. Reimer, MD,
is a family physician with Family Practice Medical Building, Hastings, Neb. Dr. Reimer earned a medical degree from the University of Nebraska College of Medicine, Omaha, and completed the friendship in sports medicine to primary care estate Moses Cone Family Practice. He also added a certificate of competency of Sports Medicine.
Karl B. Fields, MD,
Residence is a sports medicine fellowship director and director Moses Cone Family Practice Residency. It 'also Adjunct Professor and Director of the Department of Family Medicine attached to the University of North Carolina at Chapel Hill School of Medicine. After receiving a medical degree from the University of Kentucky College of Medicine, Lexington, Dr. Fields completed a residency in family medicine in Charlotte (NC) Memorial Hospital and fellowship for the academic development of the University of North Carolina at Chapel Hill. He has added a certificate of competency of Sports Medicine.
Address correspondence to Karl B. Fields, MD, Moses Cone Family Practice Residency Program, 1125 N. Church St., Greensboro, NC 27401 th Reprints are not available from the authors.
REFERENCES :
- JP Vuori, Aro HT. Lisfranc joint injuries: trauma mechanisms and associated injuries. J Trauma 1993; 35:40-5.
- Englanoff G, Anglin D, Hutson HR. Lisfranc fracture-dislocation: an often missed diagnosis in an emergency. Ann Emerg Med 1995; 26:229-33.
- Mantas JP, Burks RT. Lisfranc injuries in athletes. Sport Clin In 1994, 13:719-30.
- Trevino SG, S. Kodros Disputes tarsal injuries. Orthopedic Clin North Am 1995; 26:229-38.
- M. Myerson The diagnosis and treatment of Lisfranc joint complex injury. Orthopedic Clin North Am 1989; 20:655-64.
- Heckman JD. Fractures and dislocations of the foot. In: Rockwood CA, Green DP, Bucholz RD, ed. Rockwood and Green Fractures in adults. Vol 2. 3 rd ed. Philadelphia: Lippincott, 1991:2140-51.
- Wiley JJ. The mechanism of tarso-metatarsal joint injuries. J Bone Joint Surg [Br] 1971; 53:474-82.
- Curtis MJ, Myerson M, B. Szura tarsometatarsal joint injuries in athletes. Am J Sports In 1993, 21:497-502.
- Kraege DR. Foot injuries. In: Lillegard WA, Rucker KS, eds. Manual of sports medicine: a symptom-oriented approach. Boston: Andover Medical, 1993:159-71.
- Brown DD, RV Gumbet. Lisfranc fracture-dislocations: report of two cases. J Natl Assoc With 1991, 83:366-9.
- Arntz CT, Hansen ST Jr. Dislocations and fracture dislocations of the tarsometatarsal joints. Orthop Clin North Am 1987; 18:105-14.
- Markowitz HD, Chase M, Whitelaw GP. Isolated lesion of the second tarsus. A case report. Clin Orthopedics 1989; (248) :210-2.
- Faciszewski R, Burks RT, Manaster BJ. Subtle Lisfranc joint injuries. J Bone Joint Surg [Am] 1990; 72:1519-22.
- Faciszewski T, Burks RT, BJ Mana Rochester. Subtle Lisfranc injuries the most common [Reply to letter]. J
- Bone Joint Surge [Am] 1991; 73:1578.
- Myerson MS. Subtle Lisfranc joint injury [Letter]. J Bone Joint Surg [Am] 1991; 73:1577-8.
- Brunet JA, Wiley JJ. The results of the tarsal joint injuries final. J Bone Joint Surg [Br] 1987; 69:437-40.
0 comments
Post a Comment