(316235851) Lisfranc Fracture-Dislocations Powerpoint Presentation

7/21/2019 (316235851) Lisfranc Fracture-Dislocations Powerpoint Presentation

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Bala KatyalTrainee Advanced Practitioner Plain Film Reporting

May 2011


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Lisfranc Fracture-Dislocation

HistoryDefinition

Clinical presentationMechanism of Injury

Classifications

ImagingTreatment

Conclusion


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History

Jacques Lisfranc


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DefinitionWhere the metatarsals dislocate from their normal

articulation with the mid-tarsal bones1st 2ndMost commonly involves the

and the medial cuneiformand

metatarsals

Incidence is 1 in 55,000 peopleeachyear

Easily missed on initial x-rays

Can be difficult to diagnose


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ClinicalPresentation

Swelling

midfoot

and large lump in the

Unable to weight bearTenderness along the tarso-metatarsal joints

Tenderness with passive abduction

and pronation of the forefoot withthehindfoot held f lexed


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Clinical Presentation

Instability of the LisfrancJoint

Plantar midfoot

ecchymosis


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Mechanism Of InjuryHyper-extending the forefootCatching the forefoot in a hole in the ground

Horseback rider falling and hanging theforefootin the stirrupCommonly seen as a Charcots Joint in diabetic

PatientsRTAs especially when foot is trapped in dorsi-f lexion under the foot pedalCrush injuries


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Mechanism Of Injury

Placing the foot intoextreme plantar f lexionwith an axial load


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Classification Sprains are the most common injury to the

tarso- metatarsal ligament, it is graded I, II andIII (Burroughs et al 1998)

Grade I - Pain at the joint, minimal swelling andno instability of the joint

Grade II Increased pain and swelling of the

joint, with mild laxity but no instability Grade III Complete ligamentous disruption and

may represent a fracture-dislocation


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Classification


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Classification

Adam and Dixon 2008, say there are 2 basic typesof

Lisfranc injuries, homolateral and divergent:

Homolateral Where the metatarsals are shifted

laterally Divergent The first metatarsal shifts medially and

theremainder of the forefoot shifts laterally


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Classification


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Classification Myerson 1986, identifies 3 classifications of

Lisfranc Injuries:

Total incongruitydisplaced

Can be either medially or laterally

Medial Lateral


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Classification Partial incongruity Either medial (Type B1)or lateral

(TypeB2),themost commontype

Type B2 (complete)Type B1 Type B2 (partial)


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Classification Divergent displacementEither partial (type C1) or

total(type C2)

Type C1

Type C2


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Imaging First investigation is a plain film x-ray AP andOblique


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Imaging

Plain film plays a very important role in diagnosing

Lisfranc fracture-dislocations

To look for alignment

On the AP, the lateral border of the

1st

metatarsal is aligned with theLateral border of the medial

cuneiform


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Imaging

On the AP themedial border of2ndthe metatarsal is in line with

the medial border of the

intermediatecuneiform


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ImagingOn the oblique view

Medial and lateral borders ofthe lateral cuneiform should

align with the medial and lateral

3rd

borders of the metatarsal


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ImagingAlso on the oblique

Medial border of the cuboid shouldalign with the medial border of the4th metatarsal


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Imaging

Radiology.com 2006


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Imaging

Radiology.com 2006


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Imaging

Patients still may need further plain

filmviewsWeight-bearing AP

Weight-bearing lateralStress views done under anaesthetics


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Imaging CT plays an important role in looking at the widening of the

joint spaces

CT also can detect associated

fractures

Help with confirming thediagnosis

Help to formulate the surgical

treatment plan


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ImagingMRI can

damagebeuseful to evaluate thesofttissue

Looks atthe Lisfranc ligament

Not routinely used


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ImagingDoppler ultrasound may be used to look at the

dorsalis pedis artery if it can notbe felt by hand

Nuclear medicine could be useddistinguish any fractures

but you could not


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Fractures AssociatedDislocations

withLisfranc

2ndBase of

Cuboid

metatarsal

Fractures of theshafts

of the metatarsals1st 2ndDislocations of

the

(medial) and

(middle) and cuneonavicular jointsNavicular


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TreatmentFor a Lisfranc sprain:Non-weight bearing

In a cast orremovable

4-6 weeks recovery

Physiotherapy

boot

Gradual return toactivity


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TreatmentFor a Lisfranc fracture-dislocation,

surgery

ORIFK-Wires

Arthrodesis

itisusually

Complications

Can take up towith surgery

1 year to recover


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Examples of Lisfranc Injuries 1


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Example of Lisfranc Injuries 3


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Conclusion Serious injury

Difficult to diagnose

Can lead to compartment syndrome Can have vascular compromise if not treatedquickly

A quick and accurate diagnosis can allow the

appropriate treatment to take place efficiently Can take a long time to recover

Complications that may lead to further surgery

Advance practice plays an important role


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ReferencesADAM, A and DIXON, A.K. (2008) Grainger and Allisons Diagnostic

5thRadiology. A textbook of Medical Imaging. Edition, volume 2 inGRAINGER, R.G. and ALLISON, D.J. (eds.).

London:Churchill Livingstone

AMERICAN COLLEDGE OF FOOT AND ANKLE SURGEONS (2009)Lisfranc Injuries.

22ndAccessed April 2010)BURROUGHS, K.E. and REIMER, C.D. and FIELDS, K.B. (1998). Lisfranc

injury of the foot: A commonly Missed diagnosis.Published by the AmericanAcademy of Family Physicians

2ndCHAN, O. (2007)ABC of Emergency Radiology.

Oxford:Blackwell PublishingEdition. BMJ Books.

FOOT EDUCATION (2009) Lisfranc Fracture ORIF.

www.footeducation.com/lisfranc-fracture-orif(Accessed 14th May 2010)

2ndHELMS, C.A. (1995) Fundamentals of Skeletal Radiology.

London:W.B. Saunders Company

Edition.
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References HOWELL, G.A. (2009) Lisfranc Ligament Tear.

www.radsource.us/clinic/0908(Accessed 14th May 2010)LARSEN, D. And MORRIS, P. (2006) Limb X-Ray Interpretation.

London:Whurr Publishers

LEARNING RADIOLOGY.COM (2006) Lisfranc Fracture-Dislocation.

22ndwww.learningradiology.com(Accessed April 2010)Edition.3rdLISLE, D.A. (2007) Imaging for students:

London: Hodder Arnold

McCONNELL, J. AND EYRES, R. AND NIGHTINGALE, J. (2005)Interpreting Trauma Radiographs.

Oxford:Blackwell Publishing

MYERSON (1986) cited in East Lancashire Foot and Ankle Hyperbook,Lisfranc Injuries

23rdwww.foothyperbook.com(Accessed May 2010)RABY, N. And BERMAN, L. And DE LACY, G. (2009)Accident and

2ndEmergency Radiology. A survival Guide.London:Elsevier Saunders

Edition.
http://www.radsource.us/clinic/0908http://www.learningradiology.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.foothyperbook.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.learningradiology.com/http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908http://www.radsource.us/clinic/0908


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References

THE CENTRE FOR ORTHOPAEDICS AND SPORTS

MEDICINE(2000) Lisfranc Fracture-Dislocation22nd(Accessed April 2010)

TREVINO, S.G. (2009) Lisfranc FractureDislocation 23rdwww.emedicine.medscape.com(Accessed

VANDERHEIDEN, T. (2008) Lisfranc Injury.

May 2010)

15thwww.about.com(Accessed May 2010) WATURA ET AL. BJR 77 (Supplement 1):S46 Figure

10. 22ndwww.BJR.com(Accessed April 2010)

WHEELESS, C.R. (2009) Lisfrancs Fracture/Tarso-metatarsal

Injuries. Duke Orthopaedics presents WheelessTextbook ofOrthopaedics. 14thwww.wheelessonline.com(Accessed May 2010)
http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.about.com/http://www.bjr.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.wheelessonline.com/http://www.bjr.com/http://www.bjr.com/http://www.bjr.com/http://www.bjr.com/http://www.bjr.com/http://www.about.com/http://www.about.com/http://www.about.com/http://www.about.com/http://www.about.com/http://www.about.com/http://www.about.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/http://www.emedicine.medscape.com/


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