Subtleties of Lisfranc fracture-dislocations

Tarsometatarsal (Lisfranc) fracture-dislocations can be very difficult to recognize radiographically. The evaluation of the Lisfranc joint can be simplified by meticulously studying the alignment of the metatarsal bases with their corresponding tarsal bones. The usefulness of this observation has been confirmed by: anatomic descriptions, biomechanical analysis, and clinical foot radiographs. Subtle abnormalities identified at the Lisfranc joint using this observation included: metatarsal subluxations identified only on a single projection, associated tarsal subluxations and dislocations, irreducible metatarsal subluxations after closed manipulation, and recurrent metatarsal subluxations after reduction.