Summary A Lisfranc injury is a tarsometatarsal fracture dislocation characterized by traumatic disruption between the articulation of the medial cuneiform and base of the second metatarsal. Diagnosis is confirmed by radiographs which may show widening of the interval between the 1st and 2nd ray. Treatment is generally operative with either ORIF or arthrodesis. Epidemiology Incidence account for 0.2% of all fractures Demographics males > females more common in the third decade ETIOLOGY Pathophysiology mechanism of injury login to view 5 more bullets pathoanatomy login to view 4 more bullets Associated conditions tarsal fractures proximal metatarsal fractures login to view 2 more bullets Anatomy Osteology Lisfranc joint complex consists of three articulations including login to view 3 more bullets columns of the midfoot login to view 6 more bullets Ligaments Lisfranc ligament login to view 3 more bullets plantar tarsometatarsal ligaments login to view 1 more bullet dorsal tarsometatarsal ligaments login to view 1 more bullet intermetatarsal ligaments login to view 2 more bullets Biomechanics Lisfranc joint complex is inherently stable with little motion due to login to view 4 more bullets Classification Hardcastle & Myerson Classification Type A Complete homolateral dislocation Type B1 Partial injury, medial column dislocation Type B2 Partial injury, lateral column dislocation Type C1 Partial injury, divergent dislocation Type C2 Complete injury, divergent dislocation Presentation History history of high energy trauma or sporting accident Symptoms severe midfoot pain inability to bear weight Physical exam inspection & palpation login to view 3 more bullets motion login to view 5 more bullets provocative tests login to view 1 more bullet Imaging Radiographs recommended views login to view 5 more bullets findings login to view 15 more bullets CT indications login to view 2 more bullets MRI indications login to view 1 more bullet Differential Key Differential metatarsal base fracture metatarsal stress fracture tarsal fracture Treatment Nonoperative cast immobilization for 8 weeks login to view 8 more bullets Operative temporary percutaneous pinning and delayed ORIF or arthrodesis login to view 4 more bullets open reduction and rigid internal fixation login to view 6 more bullets primary arthrodesis of the first, second and third tarsometatarsal joints login to view 12 more bullets midfoot arthrodesis login to view 3 more bullets Technique Cast immobilization close followup with repeat radiographs should be performed to ensure no displacement with weightbearing with non-operative management Temporary percutaneous pinning technique login to view 3 more bullets timing to definitive surgery login to view 1 more bullet Open reduction and rigid internal fixation timing login to view 1 more bullet approach login to view 3 more bullets reduction & fixation login to view 4 more bullets postoperative care login to view 4 more bullets Primary arthrodesis of the first, second and third tarsometatarsal joints arthrodesis & fixation login to view 3 more bullets postoperative care login to view 3 more bullets Midfoot arthrodesis arthrodesis & fixation login to view 4 more bullets postoperative care login to view 3 more bullets Complications Posttraumatic arthritis incidence login to view 1 more bullet risk factors login to view 4 more bullets treatment login to view 1 more bullet Malunion risk factors login to view 1 more bullet treatment login to view 6 more bullets Nonunion risk factors login to view 1 more bullet treatment login to view 2 more bullets Hardware removal incidence login to view 3 more bullets Deep infection incidence login to view 1 more bullet risk factors login to view 1 more bullet treatment login to view 1 more bullet Planovalgus foot deformity risk factors login to view 2 more bullets Prognosis Overall Impact on Life Quality significant variability regarding return to full activity given heterogenous group of patients in nearly all studies login to view 1 more bullet Poor prognostic variables missed diagnosis login to view 3 more bullets