Turco's injury: diagnosis and treatment

Abstract

The aim of this study was to alert doctors to the existence of Turco's injury and discus the existing treatments that have been described in the worldwide literature. A bibliographic survey of Lisfranc's injury and Turco's injury covering from 1985 to 2013 was conducted in the SciELO and PubMed databases. Among the 193 articles, those relating to bone-ligament injuries of the Lisfranc joint and high-energy trauma were excluded, as were the case reports. The patients selected were professional or amateur athletes who solely presented a ligament injury to the Lisfranc joint (Turco's injury), which was diagnosed from the history, physical examination, radiographs and magnetic resonance images. Non-athletic patients and those with associated bone injuries were excluded (10). According to the injury classification, the patients were treated by means of either an open or a closed procedure and then a standard rehabilitation protocol. Out of the 10 patients, five underwent conservative treatment and five underwent surgical treatment using different techniques and synthesis materials. We obtained two poor results, one satisfactory, five good and two excellent. We conclude that the correct diagnosis has a direct influence on the treatment and on the final result obtained, and that lack of knowledge of this injury is the main factor responsible for underdiagnosing Turco's injury. There is a need for randomized prospective studies comparing the types of synthesis and evolution of treated cases, in order to define the best treatment for this injury.

Gravity Stress Radiograph Revealing Instability at the First Metatarso-Cuneiform Joint in Lisfranc Injury

“…Lisfranc injuries are commonly misdiagnosed, resulting in inadequate treatment and debilitating degenerative arthritis [ 1 , 4 - 7 ]. In the present case study, a gravity stress lateral radiograph effectively identified an unstable Lisfranc injury that was obscured by weightbearing views.…”

“…The Lisfranc ligament which connects the medial cuneiform to the second metatarsal base is one of the major stabilizing structures of the tarsal-metatarsal joint. Injuries to the Lisfranc ligament are common in high energy motor vehicle accidents and in low energy sports injuries when the foot is twisted while bearing weight [ 1 , 7 ]. Despite this important role in stabilizing the foot and its transverse arch, injuries to the Lisfranc ligament are commonly misdiagnosed.…”

“…Despite this important role in stabilizing the foot and its transverse arch, injuries to the Lisfranc ligament are commonly misdiagnosed. Signs of a Lisfranc injury may be subtle or absent on both physical examination and initial radiographs, contributing to clinical error [ 1 - 2 , 6 - 7 ].…”

“…Radiographic signs of Lisfranc injury and instability include subluxation of the tarsal-metatarsal joint on the lateral view and diastasis at the base of the second metatarsal and the medial cuneiform on an anteroposterior (AP) view [ 3 , 5 - 7 ]. However, non-weightbearing radiographs may not reveal subtle instability of the Lisfranc joint, which can only otherwise be seen with stress views or advanced imaging [ 4 , 6 ].…”

“…The literature indicates that up to 20% of these injuries may be misdiagnosed or missed [ 1 , 9 ]. If injuries to the Lisfranc ligament are unrecognized, the joints of the midfoot are subjected to abnormal stresses and undergo degenerative changes, resulting in arthritis [ 1 , 4 - 7 ].…”