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Irreducible Lisfranc Injury Caused by Tibialis Anterior Tendon Entrapment: Surgical Strategy and Literature Review
Satoshi Muto1, Hideyuki Ota2, Tadayori Handa2
1Department of Orthopedic Surgery, Nagoya Medical Center, Nagoya, JPN.
Lisfranc injuries are difficult to treat, particularly when reduction is blocked by soft-tissue interposition. Tibialis anterior tendon entrapment is a rare cause of irreducible Lisfranc dislocation, with only nine cases reported since 1950. We report the tenth case in a 65-year-old woman who sustained a Lisfranc fracture-dislocation after a trampoline accident. Emergency treatment consisted of closed reduction and temporary percutaneous fixation, followed by staged open reduction and internal fixation after soft-tissue swelling subsided. At definitive surgery, the tibialis anterior tendon was found entrapped between the medial and middle cuneiforms, preventing reduction. After release of the tendon, anatomic alignment was restored, and stable fixation was achieved. Although the tendon remained entrapped for 14 days, the patient had a favorable recovery, with progressive improvement in range of motion and an American Orthopedic Foot and Ankle Society midfoot score of 90 at six months. This case emphasizes the need to consider tendon interposition in irreducible Lisfranc injuries and suggests that staged surgical management may yield favorable outcomes in this uncommon setting.
Lisfranc injuries are difficult to treat, particularly when reduction is blocked by soft-tissue interposition. Tibialis anterior tendon entrapment is a rare cause of irreducible Lisfranc dislocation, with only nine cases reported since 1950. We report the tenth case in a 65-year-old woman who sustained a Lisfranc fracture-dislocation after a trampoline accident. Emergency treatment consisted of closed reduction and temporary percutaneous fixation, followed by staged open reduction and internal fixation after soft-tissue swelling subsided. At definitive surgery, the tibialis anterior tendon was found entrapped between the medial and middle cuneiforms, preventing reduction. After release of the tendon, anatomic alignment was restored, and stable fixation was achieved. Although the tendon remained entrapped for 14 days, the patient had a favorable recovery, with progressive improvement in range of motion and an American Orthopedic Foot and Ankle Society midfoot score of 90 at six months. This case emphasizes the need to consider tendon interposition in irreducible Lisfranc injuries and suggests that staged surgical management may yield favorable outcomes in this uncommon setting.
