A Lisfranc Fracture-Dislocation in a Football Player

Abstract

Injuries to the tarsometatarsal joint, also known as Lisfranc injuries, are uncommon and can be difficult to diagnose. These injuries have a high potential for causing substantial disability related to posttraumatic osteoarthritis. As a result, it is important to be alert for these injuries when evaluating patients after acute foot trauma. This case report describes a collegiate athlete with a Lisfranc fracture-dislocation. Relevant aspects of the physical examination, diagnostic imaging, and treatment considerations are discussed. Case ReportThe patient, a 22 year-old male collegiate football player, was examined on the field after sustaining an injury to his right foot. After falling on a plantarflexed, fixed foot, an axial load was applied to the posterior aspect of the patient's right heel. He developed immediate pain and swelling over the dorsum of the foot, and he was unable to bear weight on his foot. His medical and surgical history were unremarkable.When the patient was examined, he was in extreme discomfort. He had considerable swelling over the dorsum of the midfoot. His foot was diffusely tender with areas of maximal tenderness over the first and second tarsometatarsal joints, the medial cuneiform, and between the first and second metatarsal heads. The foot was otherwise neurologically intact.The patient was sent to the local emergency department for radiographs immediately after the injury. Non-weight-bearing anteroposterior, lateral, and oblique radiographs were obtained. The physicians caring for the patient in the emergency department, including the on-call radiologist, did not observe any abnormalities on the initial films. The patient was released from the emergency department with crutches and a postoperative shoe. He was told that he had a severe sprain of his foot. When the patient brought the radiographs to the training room the next day, a fracture of the medial cuneiform was seen in addition to 2 mm of widening between the medial and middle cuneiform articulation, findings consistent with a Lisfranc fracture-dislocation (Figure 1). The patient's foot was placed in a fracture boot, and he was assigned to strict non-weight-bearing status. He was then referred to a foot and ankle surgeon, who took him to the operating room 4 days after the injury for open reduction and internal fixation of both the medial cuneiform fracture and the Lisfranc dislocation. A cannulated screw was placed from the medial aspect of the medial cuneiform across the Lisfranc articulation into the base of the second metatarsal. A second screw was placed across the medial cuneiform into the middle cuneiform (Figure 2). The patient was instructed to remain non-weight bearing, and his foot was put in a cast to immobilize it. He was then given a fracture boot to wear for 6 weeks. He was gradually weaned from his fracture boot without difficulty. The hardware was removed 19 weeks after surgery. At 42 weeks after surgery and 22 weeks after removal of the screws, the patient was asymptomatic and was given permission to partic...

Turco's injury: diagnosis and treatment

“…Pain on palpation between the base of the first and the second metatarsal is an important finding, even without injuries involving diastasis of the intermetatarsal space. 12 , 15 , 16 , 17 Provocative tests may also be very helpful. The two tests most frequently used are lateral compression test and the axial stability test between the first and second metatarsals, which are positive when they reproduce pain in the midfoot.…”

“…In lateral view with loading, a dropped plantar arch or dorsal subluxation can be seen. 11 , 12 , 14 , 15 , 16 , 17 …”

“…Approximately one third of these injuries go undiagnosed, which may lead to chronic pain in the foot affected, osteoarthrosis and deformities. 1 , 3 , 10 , 11 , 12 , 13 Among the various injury mechanisms that have been described, the commonest is plantar flexion over the metatarsals, in association with rotational stress. 9 In this manner, it is important for physicians to become familiar with the types of presentation of Lisfranc dislocated fractures, and specifically the one discussed in this study, which bears the name of Turco's injury, given that early diagnosis and intervention are essential for better prognosis.…”

Fratura-Luxação De Lisfranc: uma revisão bibliográfica

“…Para o diagnóstico da lesão de Lisfranc, a anamnese e o exame físico são essenciais.Conhecendo a história clínica e sabendo que uma das queixas frequentes é a dor, a palpação com dor presente entre o primeiro e segundo metatarsais é um achado relevante, mesmo sem fratura com diástase do espaço intermetatarsal23 . Os achados patognomônicos são dor à palpação, dor a movimentação da articulação tarsometatarsal, equimose plantar na região médio-pé e limitação de sustentação depeso 24 .…”

Etiology and Biomechanics of Tarsometatarsal Injuries in Professional Football Players

“… 15 , 24 More serious dislocations may keep a player from athletic participation for 6 to 9 months if surgery is needed. 9 , 14 In extreme cases, the injury may end an athlete’s career. 12 , 16 , 21 , 29 Given the risk that these injuries pose to the careers and performance of professional football players, it is critical that the etiology and mechanisms of TMT dislocations be established to guide the development of protective countermeasures.…”