LISFRANC JOINT INJURIES - TRAUMA MECHANISMS AND ASSOCIATED INJURIES

A retrospective review of the roentgenograms of 750 patients treated i n our institution for tarsometatarsal joint injuries or metatarsal fra ctures over a 10-year-period was performed. Injuries of the Lisfranc j oint were found in 66 patients (9%). Twelve patients (19%) had a total dislocation, 47 patients (71%) a partial dislocation, and seven patie nts (11%) a subtle injury of the Lisfranc joint. Four main groups of t rauma mechanisms were identified (low-energy injuries, falls from a he ight, direct crush injuries, and high-energy vehicular crashes). Lisfr anc joint injuries caused by low-energy injuries (21 patients) were as frequent as those caused by high-energy vehicular crashes (22 patient s). There was no apparent relationship between the mechanism of injury and the type of Lisfranc joint dislocation. All patients except three had associated metatarsal fractures, most commonly in the second meta tarsal. The location of associated metatarsal fractures was different from that in patients with metatarsal fractures alone (p < 0.001). Fra ctures, dislocations, or fracture-dislocations of midtarsal bones (cun eiforms, cuboid, navicular) occurred in 26 patients (39%). Multiple me tatarsal fractures and midtarsal bone injuries were more frequent in h igh-energy vehicular crashes than in low-energy injuries (p = 0.016 an d p = 0.033, respectively). In 23 patients (35%), the treatment had be en focused on multiple metatarsal fractures or midtarsal bone injuries without full appreciation of the concomitant Lisfranc joint incongrui ty. Increasing the knowledge of normal foot anatomy and the appreciati on of the risk of Lisfranc joint injury even in seemingly trivial stum bling accidents obviously may improve the diagnosis and treatment of t hese potentially disabling injuries. The goal of treatment should be t he restoration of the normal anatomy and joint congruence.