Lisfranc Fracture-dislocation With Extensor Hallucis Brevis Tendon Interposition: A Case Report

Area of Science:

• Orthopedic surgery
• Trauma care
• Foot and ankle reconstruction

Background:

• Lisfranc fracture-dislocations are severe foot injuries requiring prompt and accurate reduction.
• Interposition of soft tissues, such as tendons, can complicate closed reduction attempts.

Purpose of the Study:

• To report a unique case of Lisfranc fracture-dislocation caused by an interposed extensor hallucis brevis tendon.
• To describe a successful staged surgical management approach for this complex injury.

Main Methods:

• A 14-year-old female presented with a Lisfranc fracture-dislocation.
• Initial closed reduction attempts were unsuccessful due to interposed extensor hallucis brevis tendon.
• Treatment involved temporizing closed reduction with percutaneous pinning, followed by open reduction and internal fixation.

Main Results:

• The staged surgical approach achieved improved alignment and stable fixation.
• The extensor hallucis brevis tendon was identified as the primary block to initial reduction.
• The patient's soft tissues allowed for definitive fixation after initial stabilization.

Conclusions:

• Anatomical reduction and stable fixation are crucial for Lisfranc injuries to prevent midfoot arthritis and collapse.
• This case is the first to document the extensor hallucis brevis tendon as a mechanical block to Lisfranc injury reduction.
• Successful management of complex Lisfranc injuries may require a staged surgical approach.