What is a Lisfranc fracture?
A Lisfranc fracture is a break to a particular area of the middle portion of the foot, or midfoot, with disruption of the Lisfranc ligament. This ligament attaches the base of the second metatarsal bone to the medial cuneiform, and it is vital in supporting the arch of the foot. Disruption of the Lisfranc ligament is also commonly associated with multiple fractures through the midfoot.
Whether the injury includes fractures or is purely ligamentous, our Cypress orthopedist recommends surgery for optimal outcomes. Without surgery, collapse of the arch of the foot and midfoot arthritis will quickly develop.
Mechanism of a Lisfranc fracture
Lisfranc fractures were initially described as stirrup injuries, in which sudden pressure of the foot against the stirrup resulted in disruption of the Lisfranc ligament. Today, our Cypress orthopedist also sees these injuries in motor vehicle accidents when the foot is jammed against the brake, direct crush injuries to the midfoot and significant impact to the top of a plantar flexed foot (pressure on the ball of the foot).
Diagnosing a Lisfranc fracture
X-rays are the initial diagnostic tool of choice for a Lisfranc fracture. Unfortunately, they are one of the most commonly missed injuries in emergency rooms. To reliably detect a Lisfranc fracture, a weight-bearing x-ray must be obtained and emergency departments will often only perform non-weight-bearing x-rays. If there is high suspicion of a Lisfranc injury without any radiographic evidence, an MRI may be obtained to confirm the diagnosis.
Treatment and recovery
Lisfranc injuries generally require surgical intervention to avoid long-term complications. Surgery at our Cypress orthopedist typically involves stabilization of the Lisfranc joint, and any other associated midfoot fractures or joint disruptions, with plates, screws and wires.
In older patients or patients with poor bone quality, fusion rather than fixation of the affected joints may be preferred. Because the Lisfranc joint and the surrounding joints are not significantly mobile to begin with, fusion of these joints does not significantly limit the range of motion of the foot.
Whether fixation or fusion of the Lisfranc fracture is performed by our Cypress orthopedist, the plates and screws placed into the foot are usually left in place unless they become painful or prominent. If wires are also used, these will be removed once the injury has sufficiently healed.
Lisfranc fracture surgery is an outpatient procedure. For the injury to properly heal, an extended period of immobilization and non-weight-bearing is required. In most cases, immobilization in a series of casts, and eventually a boot, is required for approximately 14 weeks.
Usually patients are advised to remain completely non-weight-bearing for about 10 weeks. Failure to remain non-weight-bearing may result in hardware failure and the need for additional surgery or prolonged immobilization.
Contact us to schedule an appointment to learn more about how our Cypress orthopedist diagnoses and treats a Lisfranc fracture.
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