The Lisfranc Injury: A Literature Review of Anatomy, Etiology, Evaluation, and Management

Abstract

Despite being first described in the 1800s, the Lisfranc injury remains one of the most controversial topics in foot and ankle surgery. From the basic anatomy of the ligament complex to the optimal diagnostic and management methods, new research both sharpens and yet confounds our understanding of this unique injury. This article reviews the literature from established and classic papers to recent studies evaluating newer techniques. We discuss the unique bony and ligamentous anatomy, which confer strength to the Lisfranc complex, the typical mechanisms of injury, the most common classification systems, the clinical presentation, current imaging modalities, and conservative and surgical treatment options. We review studies comparing open reduction and internal fixation with primary arthrodesis of acute injuries, in addition to studies evaluating the various methods for obtaining fixation, including intra-articular screws, dorsal plates, and flexible fixation. It is clear from this review that despite the vast number of studies in the literature, much is still to be learned about the diagnosis and management of this challenging injury. Levels of Evidence: Level V: Expert opinion

Bilateral Lisfranc Injury in a Young Female: A Case Report

“…Radiological clues can be aided by clinical examination findings. These may include midfoot swelling, plantar ecchymosis, localized tenderness, positive rotational and stress tests, positive piano key test, and pain or instability with passive abduction of the midfoot while stabilizing the transverse tarsal joint [ 3 , 10 ]. The piano key test is performed by moving the head of the affected metatarsal while holding the midfoot firmly, which can help in isolating the exact TMTJ affected [ 10 ].…”

“…These may include midfoot swelling, plantar ecchymosis, localized tenderness, positive rotational and stress tests, positive piano key test, and pain or instability with passive abduction of the midfoot while stabilizing the transverse tarsal joint [ 3 , 10 ]. The piano key test is performed by moving the head of the affected metatarsal while holding the midfoot firmly, which can help in isolating the exact TMTJ affected [ 10 ]. In patients who are able to bear weight, such as our patient, midfoot stability can be assessed by having the patient attempt a single-limb toe rise [ 10 ].…”

“…The piano key test is performed by moving the head of the affected metatarsal while holding the midfoot firmly, which can help in isolating the exact TMTJ affected [ 10 ]. In patients who are able to bear weight, such as our patient, midfoot stability can be assessed by having the patient attempt a single-limb toe rise [ 10 ].…”

“…Non-displaced injuries on weight-bearing x-rays are typically treated non-operatively by a non-weight-bearing below-knee cast [ 7 , 10 , 11 ]. Open or displaced fractures are treated by either open reduction and internal fixation (ORIF) or closed reduction with percutaneous pinning or primary arthrodesis [ 5 , 7 , 8 , 12 ].…”

“…There still remains a debate between ORIF and primary arthrodesis, a method of treating Lisfranc injuries [ 10 ]. Due to such contradiction and the presence of advantages and disadvantages to both treatment modalities, it is now currently left to the discretion of the primary surgeon.…”