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Lisfranc injuries
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
The plantar ligaments are better defined medially. The first cuneiform-metatarsal ligament is broad, and no plantar ligament exists between the middle cuneiform and 2nd metatarsal. The strongest, plantar ligament is the oblique ligament from the medial cuneiform to the 2nd and 3rd metatarsal bases (Figure 16.5). Recent studies have discovered a plantar ligament, the lateral Lisfranc ligament that spans from the 2nd to 5th metatarsal and this may explain the pattern of homolateral and divergent patterns of Lisfranc injury (9). The Lisfranc complex is also stabilised dynamically by muscle and tendons such as tibialis posterior, tibialis anterior and the plantar fascia. The dorsalis pedis artery and deep peroneal nerve cross the TMT complex deep to extensor hallucis brevis. The artery passes between the 1st and 2nd metatarsal and gives a branch to the deep plantar artery which forms the plantar arch. Avulsion of the artery can occur following injury.
Lisfranc Injury
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
I would also look for any evidence of fractures in or widening between the cuneiforms. Any abnormalities may all be accentuated on weight bearing radiographs. Computed tomography can be used to image fractures and exclude occult injuries while MR imaging may allow direct visualisation of the Lisfranc ligament itself.
Musculoskeletal system
Published in David A Lisle, Imaging for Students, 2012
Any of the tarsal bones may be fractured. With major trauma, dislocation of intertarsal or tarsometatarsal joints may occur. Lisfranc fracture/dislocation refers to disruption of the Lisfranc ligament, with midfoot instability. Lisfranc ligament joins the distal lateral surface of the medial cuneiform to the base of the second metatarsal, and is a major stabilizer of the midfoot. Radiographic signs of Lisfranc ligament disruption may be difficult to appreciate, and include widening of the space between the bases of the first and second metatarsals and associated fractures of metatarsals, cuneiforms and other tarsal bones (Fig. 8.50). CT or MRI may be required to confirm the diagnosis.
Lisfranc injury: Prevalence and maintaining a high index of suspicion for optimal evaluation
Published in The Physician and Sportsmedicine, 2022
Michael C. Meyers, James C. Sterling
Anterior-posterior (AP), lateral and 30-degree oblique plain radiographs are the typical views that are ordered and may be normal in first or second-degree sprains as these injuries can be subtle. Weight bearing films are highly suggested because of this issue and must be a bilateral comparison of both feet [73–75]. When evaluating radiographs in Lisfranc injuries, three anatomic relations should be evaluated. These include a) the medial border of the middle cuneiform should align with the second metatarsal border medially on the AP film; b) on the oblique view, the medial border of the lateral cuneiform should align with the base of the third metatarsal medial edge as well as the cuboid medial border should line up with the medial edge of the fourth metatarsal; c) on the lateral view, no metatarsal should be offset superiorly or inferiorly with the respective tarsal bone. Any disruption of these relationships indicates a Lisfranc joint injury [76]. A pathognomonic finding in Lisfranc injury is the “fleck sign”, which is reported in 90% of Lisfranc ligament injuries and is defined as an avulsion type fracture at the base of the second metatarsal [59]. Also considered suspicious in tarsal/metatarsal joint injury is the presence of proximal metatarsal fractures. Since radiographs have limited sensitivity and specificity for some tarsometatarsal joint injuries, advanced imaging such as CT scan and MRI should also be obtained. CT scan allows for assessment of fractures and surrounding joint stability [77,78]. MRI allows for evaluation of isolated tears of the Lisfranc ligament as well as other surrounding ligaments [79]. Raikin and colleagues [80] reported that an MRI is accurate for identifying injury to the Lisfranc ligaments as well as adding predictive information for Lisfranc joint complex instability. Diagnostic ultrasound has been used to observe the joint dynamically, and bone scans are used for identification of degenerative changes in chronic fractures/dislocation post injury [81,82].