Abstract
The extent and patterns of Lisfranc joint complex disruption in subtle Lisfranc injuries have not been well clarified. We reviewed the direct intraoperative findings for 87 patients, examined computed tomography images that had been obtained preoperatively for 73 of the patients, and classified the injuries according to the Kaar et al. criteria as the transverse type (instability between the first cuneiform [C1] and the second metatarsal [M2] and between the second cuneiform [C2] and M2) or longitudinal type (instability between C1 and M2 and between C1 and C2). Our patients’ injuries were classified as follows: longitudinal type (38%), transverse type (30%), transverse type and first tarsometatarsal (TMT) joint injury (20%), longitudinal type plus transverse type (7%), longitudinal type and first TMT joint injury (3%), and longitudinal type, transverse type, and first TMT joint injury (2%). In 11 patients, the longitudinal injury extended into the naviculo-first cuneiform joint. In 41 (56%) of the 73 patients for whom CT images were obtained, 1 or more fractures (not counting small avulsion fragments between C1 and M2) were found. Orthopedic surgeons should be aware of the various injury patterns possible in cases of subtle Lisfranc injury.
Highlights
Subtle Lisfranc injuries due to low-energy trauma result in midfoot instability, and misdiagnosis or inadequate treatment can lead to considerable long-term disability, including chronic instability, degenerative arthritis, flatfoot deformity, and long-standing pain[1,2,3]
We classified each injury pattern as simple or complex
Subtle Lisfranc injury often occurs in high-demand, physically active individuals who are involved in sports activities[1,2,8,16,18,19,20]
Summary
Subtle Lisfranc injuries due to low-energy trauma result in midfoot instability, and misdiagnosis or inadequate treatment can lead to considerable long-term disability, including chronic instability, degenerative arthritis, flatfoot deformity, and long-standing pain[1,2,3]. These injuries are distinct from those due to high-energy trauma, such as that occurring in a motor-vehicle accident or fall from a height and accompanied by fracture and/or dislocation of bones and joints. Our aims were to identify the specific patterns of injury and the prevalence of each pattern and to determine the prevalence of fracture among patients with a subtle Lisfranc injury
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