Classifying the Lisfranc injury: Literature overview and a new classification

Abstract

Summary Introduction Injuries to the tarsometatarsal (Lisfranc) joint cover a broad range from subtle, ligamentous injuries to complex fracture-dislocations with severe soft tissue trauma. Almost all existing classifications for injuries at the tarsometatarsal joint either describe the direction of displacement or are based on the trauma mechanism as recollected by the patient. In the current study the literature is reviewed to obtain insight in the existing classifications regarding tarsometatarsal joint injuries (Lisfranc injuries). A new classification is presented based on biomechanics and injury severity. Material and method The electronic databases up to May 1st 2018 of ‘Pubmed Medline’, ‘EMbase’, and ‘Google Scholar’ were searched. Expert consensus was reached on a new classification proposal. Results Based on the literature on biomechanics at the tarsometatarsal level, the foot is divided into a medial (M), central (C) and lateral (L) column. A simple classification is proposed based on the severity of the damage to the tarsometatarsal joint per column. The different grades of injury are: 0, not involved; 1, pure ligamentous injury; 2, simple fracture; 3, comminuted fracture. Conclusion The proposed classification allows for classification of all types of injury ranging from subtle to frank fracture-dislocations. The next step will have to be to validate the classification using inter- and intra-observer agreement.