Lisfranc fracture-dislocations: current management.

Area of Science:

• Orthopedic Surgery
• Anatomy
• Radiology

Background:

• Tarsometatarsal (TMT) or Lisfranc joint injuries are often missed, with up to 20% diagnosed late, particularly low-energy or ligamentous injuries.
• Delayed diagnosis can lead to severe sequelae like post-traumatic osteoarthritis and foot deformities, causing significant disability.

Purpose of the Study:

• To emphasize the importance of understanding TMT joint anatomy for accurate diagnosis and treatment of injuries.
• To highlight clinical and radiological signs and diagnostic modalities for Lisfranc joint injuries.
• To discuss current controversies and preferred surgical management strategies for Lisfranc injuries.

Main Methods:

• Review of clinical and radiological signs for TMT joint injuries.
• Consideration of weight-bearing radiographs and computed tomography (CT) scans for diagnosis.
• Discussion of conservative versus surgical treatment indications.
• Analysis of surgical techniques, including open reduction and internal fixation (ORIF) with transarticular screws or dorsal plates.

Main Results:

• Conservative treatment is indicated only for stable, non-displaced lesions, involving immobilization and non-weight-bearing.
• Surgical treatment aims for optimal anatomical reduction and stability of the tarsometatarsal joints.
• Open reduction and internal fixation (ORIF) is the preferred surgical approach, utilizing transarticular screws or dorsal plates for comminuted fractures.

Conclusions:

• Accurate diagnosis and timely treatment of Lisfranc joint injuries are essential to prevent debilitating sequelae.
• Weight-bearing radiographs and CT scans are valuable diagnostic tools.
• ORIF with screws or plates is a preferred surgical method for unstable Lisfranc injuries, addressing anatomical reduction and joint stability.