Homolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Traumatology

Background:

• Lisfranc injuries involve the tarsometatarsal (TMT) joint complex, ranging from sprains to severe dislocations.
• While return to sport (RTS) is documented for low-energy injuries, no literature addresses RTS after homolateral fracture/dislocation of all five metatarsals.

Purpose of the Study:

• To present a novel surgical technique for repairing homolateral Lisfranc fracture/dislocation of all five metatarsals.
• To demonstrate the potential for high-level athletes to return to competition following this severe injury.

Main Methods:

• A dual surgical approach was employed: dorsal for TMT joint fusion (2nd and 3rd metatarsals) and medial for internal bracing of the 1st TMT joint.
• The technique involved cartilage removal, rigid fixation for fusion, and internal bracing using the Arthrex InternalBrace system with SwiveLock anchors and FiberTape suture.
• Specific procedural steps included guidewire insertion, drilling, tapping, and anchor placement in the metatarsal base and medial cuneiform.

Main Results:

• The athlete returned to full competition 9 months post-surgery.
• Postoperative physical examination revealed stability in dorsiflexion and abduction.
• Weight-bearing X-rays and CT scans confirmed no hardware failure, stable 1st TMT joint, and solid fusion of the 2nd and 3rd TMT joints.

Conclusions:

• This novel surgical technique is the first to report successful return to sport for a high-level athlete with a homolateral fracture/dislocation of all five metatarsals.
• The dual-approach repair offers a viable option for managing severe Lisfranc injuries in athletes aiming for competitive return.