Lisfranc injuries: Incidence, mechanisms of injury and predictors of instability

Abstract

In Lisfranc injuries the stability of the tarsometatarsal joints guides the treatment of the injury. Determining the stability, especially in the subtle Lisfranc injuries, can be challenging. The purpose of this study was to identify incidence, mechanisms of injury and predictors for instability in Lisfranc injuries. Methods:Eighty-four Lisfranc injuries presenting at Oslo University Hospital between September 2014 and August 2015 were included. The diagnosis was based on radiologically verified injuries to the tarsometatarsal joints. Associations between radiographic findings and stability were examined. Results:The incidence of Lisfranc injuries was 14/100,000 person-years, and only 31% were high-energy injuries. The incidence of unstable injuries was 6/100,000 person-years, and these were more common in women than men (P=.016).Intraarticular fractures in the two lateral tarsometatarsal joints increased the risk of instability (P=.007). The height of the second tarsometatarsal joint was less in the unstable injuries than in the stable injuries (P=.036). Conclusion:The incidence of Lisfranc injuries in the present study is higher than previously published. The most common mechanism of injury is low-energy trauma.Intraarticular fractures in the two lateral tarsometatarsal joints, female gender and shorter second tarsometatarsal joint height increase the risk of an unstable injury.

Rotational Ankle Fracture Dislocation With Associated Lisfranc Fracture

“…Lisfranc injuries most commonly occur from an axial loading mechanism on a plantarflexed foot [ 6 ] while ankle fractures are commonly rotational injuries [ 8 ]. Lisfranc injuries are often missed or diagnosed late [ 2 , 12 , 13 ], especially in the polytrauma patient setting [ 14 ]. A literature review of this unique injury pattern provided only one other case report of a higher energy motor vehicle accident which is more commonly associated with an axial load Lisfranc injury [ 11 ].…”

“…While Lisfranc injuries are commonly thought to be associated with high-energy trauma, a recent yearlong survey performed in Norway evaluating the injury mechanism of Lisfranc injuries in 84 patients demonstrated that the most common mechanism of injury was in fact low-energy mechanisms such as fall from own height or a rotational injury to the foot [ 13 ]. Furthermore, a study performed at a military tertiary center found that in a five-year time period, 60% of operatively treated Lisfranc injuries were low-energy mechanisms [ 12 ].…”

“…Furthermore, a study performed at a military tertiary center found that in a five-year time period, 60% of operatively treated Lisfranc injuries were low-energy mechanisms [ 12 ]. Low-energy mechanisms were defined as athletic activity, ground-level twisting, fall from less than 4 feet, falling downstairs, or bike accidents [ 12 , 13 ]. These studies are important as they demonstrate that Lisfranc injuries may be more common in low-energy mechanisms than previously thought and that clinicians should have a higher suspicion of Lisfranc injury in low-energy trauma patients.…”

First Step Evaluation of Patient with Foot and Ankle Injury

“…Being stomped on the knee (e.g., football players) or skipping one step while descending the stairs and falling on the next step when the foot in plantar flexion, or falling from a horse with the foot stuck in the stirrup are common causes of Lisfranc injuries 33 .…”

Clinical study on the surgical treatment of atypical Lisfranc joint complex injury

“…The incidence of Lisfranc injury is relatively low. According to related reports, the incidence rate in the United States is 1/60000, accounting for only 0.2% of total body fractures[ 1 , 2 ]. There are no specific statistics in China.…”