Lisfranc Fracture Dislocation In A Fencer

Abstract

HISTORY: A 21 year-old female fencer presented to the training room for a preparticipation physical exam. She grew up in Latvia, where she competed on the national team. One month prior to her arrival, she sustained an inversion injury to her right ankle while competing in a tournament. She was told she had a sprained ankle. Treatment thus far only included crutches and heat. PHYSICAL EXAM: With ambulation there was a noticeable limp when weight bearing on the right foot. The right foot and ankle were swollen, through the dorsum of her midfoot. There was tenderness to palpation of the ATFL, and CFL ankle ligaments. In addition she was tender over the dorsal surface of the forefoot and midfoot. With ankle active range of motion, plantar and dorsiflexion was approximately 5 degrees. Anterior drawer was equal to other side with firm endpoint. Talar tilt was positive for pain but negative for increased laxity. There were no sensory deficits. DIFFERENTIAL DIAGNOSIS: Ankle ligament sprain Midfoot ligament sprain Lateral malleolar fracture Metatarsal and/or tarsal fracture Soft tissue and/or bony contusion TEST AND RESULTS: Ankle anterior-posterior, lateral and mortise view radiographs -No fracture or dislocation noted. Foot anterior-posterior, lateral and oblique view radiographs -Lisfranc fracture dislocation. With a flex sign and dorsal dislocation of the second metatarsal base. FINAL WORKING DIAGNOSIS: Right foot closed displaced Lisfranc fracture dislocation TREAMENT AND OUTCOMES: Referral to orthopedic foot and ankle specialist. Open reduction internal fixation of Lisfranc fracture dislocation with external fixator. Non-weight bearing. Removal of lateral external fixator at 8 weeks post-op. Serial repeat radiographs with and post external fixator, displayed good reduction and healing. Placement in low-tide walking boot, with non-weight bearing for an additional 1–1/2 weeks and initiation of gentle range of motion of ankle and toes. Discontinued boot, weight bearing begun 12 weeks post injury and rehabilitation with athletic training staff started. Rehabilitation included foot and ankle range of motion and strengthening exercises. Along with quadriceps, hamstring and calf strengthening. Athlete returned to sport 8 months after injury. At next season's preparticipation exam athlete reported no foot pain with ambulation or fencing. Athlete was able to meet demands of sport and was cleared to compete again.