Anatomic Predisposition to Ligamentous Lisfranc Injury: A Matched Case-Control Study
ABSTRACT Subtle, or ligamentous, Lisfranc injuries occur following low-energy trauma to the midfoot and can be debilitating. Since they are ligamentous, they may not heal, requiring arthrodesis in some cases. Certain mortise anatomic characteristics on radiographs have been shown to be associated with a predisposition to the ligamentous subtype of Lisfranc injuries. It is not known whether there are other morphometric characteristics, such as arch height or the relative length of the second metatarsal, that can similarly influence the predisposition to these injuries.
The present retrospective matched case-control study involved fifty-two control subjects and twenty-six patients with ligamentous Lisfranc injuries treated from 2006 to 2010 at two institutions. Clinical and radiographic data (second metatarsal length relative to foot length, first intermetatarsal angle, navicular-cuboid overlap relative to cuboid vertical height, first metatarsal-talus angle, and calcaneal pitch angle) were examined for the existence of significant differences between control and Lisfranc subjects. Logistic regression analysis was then performed to evaluate potential risk for injury on the basis of these anatomic variables.
Compared with matched controls, patients with a ligamentous Lisfranc injury were found to have a significantly smaller ratio of second metatarsal length to foot length (p < 0.001) on weight-bearing radiographs.
Occurrence of a ligamentous Lisfranc injury was shown to be associated with a smaller ratio of second metatarsal length to foot length; >50% of patients in the injury group had a ratio of <29%.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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ABSTRACT: In fifteen patients, a subtle injury of the Lisfranc joint (tarsometatarsal articulation) was found. The lesion was defined as a diastasis of two to five millimeters between the bases of the first and second metatarsals, as seen on anteroposterior radiographs. There often was a long delay between injury and diagnosis. Eight patients were treated with a below-the-knee cast only, three had treatment with a cast and then tarsometatarsal arthrodesis, two had no initial treatment but later had arthrodesis, and two had open reduction and internal fixation. The duration of follow-up ranged from two to thirteen years after the diagnosis. There was no correlation between the severity of the diastasis and the patient's functional result. Marked disability and pain persisted in seven patients, and six of them had flattening of the longitudinal arch. Maintenance of the longitudinal arch usually was associated with a better functional outcome. When a patient has a subtle injury of the Lisfranc joint, weight-bearing lateral radiographs of both feet are needed to identify flattening of the longitudinal arch. Such radiographs should be made routinely in the evaluation of all injuries of the foot that may involve the Lisfranc joint.The Journal of Bone and Joint Surgery 01/1991; 72(10):1519-22. · 4.31 Impact Factor
Article: Lisfranc fracture-dislocations.Clinical Orthopaedics and Related Research 02/1963; 30:116-29. · 2.88 Impact Factor
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ABSTRACT: Seventy-two patients with 76 fracture-dislocations of the Lisfranc tarsometatarsal joint complex were evaluated. Fifty-eight (81%) were polytrauma patients and the remainder suffered isolated injuries. Sixty of the original 72 patients were available for long-term study. Eight of these had an amputation at or shortly after the original admission, leaving 52 patients with 55 Lisfranc injuries for analysis. The average length of follow-up was 4.2 years (range, 20 months to 11 years). According to the Painful Foot Center scoring system, 27 feet (49%) achieved an excellent or good result and 28 (51%), a fair or poor result. Direct crush injuries did poorly with only one of eight scoring good or excellent. Of the various treatment modalities, open reduction and internal fixation with Kirschner wires yielded the best results. The major determinant of unacceptable results was identified as the quality of the initial reduction. Tarsal instability and late degenerative joint disease caused most of the symptoms. Twenty-three of the 52 patients (44%) have had or should have further mid-foot surgery to improve function and comfort. Because our results were often poor, our present protocol includes closed or open reduction and Kirschner wire internal fixation. Displacement greater than 2 mm or a talometatarsal angle greater than 15 degrees on radiographs following a closed reduction mandates open reduction.Foot & ankle 05/1986; 6(5):225-42. DOI:10.1177/107110078600600504