Lisfranc Fracture
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Transcript of Lisfranc Fracture
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Foot Case #4
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24 YOF presents with severe pain in right foot. She was windsurfing when a strong gust blew her over. Her right foot remained strapped in place. She c/o severe pain across top of her right foot which is made worse with all movement. Denies pain in her ankle, knee, and thigh of RLE.
History and PhysicalT 97.4 P 112 BP 154/92
O2 97%Gen: Severe discomfort
2/2 pain.CV: Sinus tach, no m/r/gPulm: CTAB.MSK: R foot w/o bony
abnormalities. NV intact. TTP across dorsum. Pain elicited with torsion of midfoot and passive dorsi- and plantar flexion of R foot.
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Image
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Lisfranc Fracture
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Non-Displaced (<1mm):Elevate and Ice FootAnalgesicsImmobilize – Posterior SplintNon-weight bearingFollow up with Orthopedics in 2 weeks
ED Management
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Displaced (unstable injury):Elevate and Ice FootAnalgesicsRequire emergent reduction Emergent ortho consult
ED Management
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Lisfranc joint is found at the base of second metatarsal and is formed by a 6-bone arch that includes the first, second, and third cuneiforms and first, second, and third metatarsals
Named by a French OBGYN in the Napoleonic wars
Most commonly misdiagnosed foot fracturesTo facilitate diagnosis, grasp first and second
metatarsals and move them alternately through plantarflexion and dorsiflexion.
Pearls
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Additional Images
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Tintinalli's Emergency Medicine: A Comprehensive Study Guide. O. John Ma, M.D., Judith E. Tintinalli, J. Stephan Stapczynski, David M. Cline. McGraw-Hill Professional Publishing: 2010.
Wheeless Textbook of Orthopedics. Clifford R Wheeless, MD.
Missing the Lisfranc fracture: a case report and review of the literature. Rijn J, Dorleijn DM, Boetes B, Wiersma-Tuinstra S, Moonen S. J Foot Ankle Surg. 2012 Mar-Apr;51(2):270-4.
Radiology case of the month. Foot pain and swelling. Lisfranc fracture-dislocation with associated ligamentous tear. Ploch SE, Le KL, Lindfors DP, Neitzschman HR. J La State Med Soc. 2011 Mar-Apr;163(2):88, 90
References