Lisfranc fractures


AProject Paper submitted in partial fulfillment of the courserequirements for

BHS4009 – Principles of Sports Medicine

NovaSoutheastern University&nbsp


Sportsrelated fractures are those that occur in player’s body partsresulting from an accident. Fractures are serious and could result indeath. However, it is quite relieving that the frequency ofoccurrence of sports related brain injuries have reduced followingadoption of organized sports, as well as standardization of rules.Sports related brain injuries occur when sportsmen come in physicalcontact with other sportsmen, people or objects, and this is commonin sports such as boxing, ice hockey, football, skateboarding,skiing, martial arts, rugby, wrestling , snowboarding, auto racing,lacrosse, equestrian, soccer, cycling, and roller blading. Lisfrancfractures are one of the types of sports related injuries and need tobe accorded a lot of importance by understanding a number ofunderlying characteristics (Thordarson&amp Hurvitz, 2010).


Lisfrancfractures, also known as Lisfranc sprains or Lisfranc dislocation ormidfoot injury is an injury of the foot that results in thedisplacement of the bone metatarsals from the tarsus. This form ofbone injury is named after French gynecologist and surgeon JacquesLisfranc, who first made a description of the injuries in 1815. Itwas during the Napoleonic wars that Jacques Lisfranc came across acase of an injury in which one of the soldiers had fallen from ahorse, resulting in vascular compromises, as well as secondarygangrene. Lisfranc conducted an amputation at tarsometatarsaljoint level, in what became Lifranc joint. Despite the fact thatLisfranc did not offer a description of the mechanisms resulting inthe injury, Lifranc injury is now widely applied in referring to thefracture at the tarsometatarsal joints.

Asdocumented by Thordarson,Hedman Grosand (2009), Lisfrancfractures are not pronounced, and account for only 0.2 percent of allfractures. The incidences of are often reported inone per population of 55, 000 people in the US.


Thecauses of the are well documented. Human’s midfoot comprises of five types of bones, which constitute the arches offoot. These include three cuneiforms, the cuboid and navicular bones.These are articulated with the bases of the five metatarsals. are triggered when the mid foot is subjected toexcessive kinetic energy, as often evidenced in physical sports.These assume two fashions: indirectly and directly. Direct Lisfrancfractures are those resulting from the crush injuries, such as whenan object hits the mid foot, when it is run over, or when a playerlands on a foot following a fall from great height. Indirect Lisfrancfractures are those that result from sudden rotational forces whenthe foot is under compression. One of the examples of indirect is when a joker falls from a horse, but the footis trapped in the stirrup.

Inthe context of athletics, are commonly associatedwith activities such as wakeboarding,windsurfing and snowboarding, wherein binding appliances are passedto metatarsals directly. In American football, Lisfrancfractures are common because the feet of athletes are planter flexedand another players land on the heels. This is also common is sportssuch ballerinna spinning and baseball catcher, which involve pivotingathletic positions. Lisfranc factures are also common in non-contactsports such women gymnastics


Thediagnosis of mid foot injury involving much kinetic energy or fallfrom great heights is not challenging, in theoretical terms. This isbecause the fractures would be accompanied by visible deformities,which are clearly visible using x rays images. Furthermore, in manycases, the nature of the injuries would result in the increasedclinical suspicion, while the fractures could also be signified bydisrupted overlying skin that constrain the flow of blood.Essentially, x ray images would reveal a created gap between thefirst and the second toe’s bases.

Themost challenging diagnosis of this type of fractures are those thatinvolve low energy, such as those that entail a twisted injury orwhen a footballers force back on feet that are entirely in theplantar fixed positions. Consequently, the injury is associated withcomplaints such as the limited ability to bear weight, as well asswellings in the mid foot and the fore foot. These could also beaccompanied by bruised arc, although there are cases of fractures inwhich the arc bruises are absent (Sangeorzan&amp Veith, 2006).

Conventionalradiographic approaches are the reliable techniques are adopted,complemented by non-weight bearing view. This could be furthersupplemented by the weight bearing views that reveal the widenedinterval between the two toes. This is particularly appropriate forthe cases in which the initial radiographic views have failed toidentify abnormalities. Nevertheless, it is unfortunate thatradiograph sensitivity of non-weight bearing views rate about 50percent, while that of the weight bearing is about 85 percent. Theimplication of this is that 15 percent of the cases in which Lisfrancfractures could be diagnosed to be falsely absent. In case thesetests have failed to test positive and suspicion remains high,physicians could seek to adopt other sophisticated techniques ofdiagnosis. Such approaches could include x ray computed tomographyand magnetic resonance imaging (Mulier,Reynders, &amp Sioen W, etal,2013).

Threeclasses of can be revealed by the diagnosis. Theseare divergent, isolated and homolateral fractures. In divergentfractures, all the metatarsals are displaced along a sagittal plane.These could also involve the area around the intercuneiform, whichcould also involve navicle fractures. In isolated ,at least one of the metatarsals are displaced from the rest.Homolateral fractures are where all the metatarsals are displacedalong one direction, but lateral forms of displacement could alsodenote cuboidal fractures.


Thereare two types of treatment that is recommended for the cases of. These are nonoperative treatments and theoperative treatments. Relatively minor dislocation such as those thatare less than 2mm could be managed through six month casting. Thepatients are not allowed to bear any weight during this period. Thetreatment of severe entails temporary screw oropen reduction with normal internal fixation operations. Similarly,the foot would not be allowed to bear weight during six months oftreatment. These could be followed by partial weigh bearing, and fullweight bearing may follow several weeks later, depending on thenature of the injury. K- wires are removed six weeks before theperiod of weigh bearing, while screws could be ejected after a periodof 12 weeks (Arntz,Veith &amp Hansen, 2010).

Itis worth noting that the cases of Lisfranc fracture in whichtarso-metatarsal joints are significantly displaced are relativelyserious. The administration of non-operative treatment may result inthe long-term disability. It could also be accompanied by theplanovalgus deformities, as well as chronic and secondary pain. Casesof severe pain, progressive deformities and loss function, in whichnon operative treatment has failed to be effective, tarsometatarsaland mid-tarsal arthrodesis, which entail operation of fusing thebones together, is recommended. Accordingto Thordarson and Hurvitz (2010),as significant as 40 percent of Lisfranc dislocations accompanied bypolytrauma go unrecognized, while 20 percent misdiagnosed. Lisfrancfactures are common in men by about two to four times the cases ofwomen. Posttraumatic arthritis is the most common problem associatedwith the Lisfranc injury. This results from the failure to diagnoseor treat the injuries effectively.


Lisfrancfractures can be perceived as a broad spectrum of injuries. Lisfrancfracture should be treated with high suspicion index, promptingtimely diagnosis and effective treatment that should allow victimsreturn to their normal forms. Non-operative forms of treatment shouldbe reserved stage 1 sprains. The operative treatment aims atachieving stable anatomic reductions. Percutanous reduction isrecommended for minimal displacement. Formal OIF is recommended forthe cases in which perfect reduction has not been obtained.


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MulierT, Reynders, P, &amp Sioens W, etal(2013). The treatment of Lisfranc injuries. ActaOrthop Belg63:82.

SangeorzanB. &amp Veith R. (2006). Hansen ST Jr. Salvage of Lisfranc’s TMTjoint by arthrodesis. FootAnkle10:193.

ThordarsonD., Hedman T. &amp Gross D. (2009). Biomechanical evaluations ofpolylactide absorbables screws used for syndesmosis injuries repair.FootAnkle Int18:622.

Thordarson,D. &amp Hurvitz, G. (2010). PLA screw fixation of Lisfranc injuries.FootAnkle Int23:1003.