Lisfranc Fractures

AP, true lateral and oblique radiographs are required. Occasionally these injuries reduce spontaneously leaving little radiographic evidence. Fractures near the base of metatarsals should raise suspicion and prompt closer examination. The base of second metatarsal is fractured in 75% of Lisfranc injuries (VouRi and Aro 1993 Wiley 1981). A fracture of the second metatarsal with a cuboid fracture is strongly indicative. On the AP and oblique radiographs a Lisfranc fracture dislocation can be diagnosed by loss... 

The most common mechanism for injury is forced plantar flexion of the forefoot usually combined with a rotational force (Wiley 1981). Fracture dislocations of the tarsometatarsal joint are rare injuries in children but can often be overlooked. Missed Lisfranc injuries predispose to midfoot instability with chronic deformity and pain, making diagnosis important. Bruising in the sole at the level of the tarsometatarsal joint should raise specific concern for a Lisfranc injury. 

Fig. 16.6. a Divergent Lisfranc injury with loss of alignment of medial border of second metatarsal and medial border of medial cuneiform, b Convergent Lisfranc. Note fracture fragments from second metatarsal base. (Images provided by Dr. Davies and Dr. Teh)... 

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