Unusual presentation of Lisfranc fracture dislocation associated with high-velocity sledding injury: a case report and review of the literature

Journal of Medical Case Reports, Aug 2008

Introduction Lisfranc fracture dislocations of the foot are rare injuries. A recent literature search revealed no reported cases of injury to the tarsometatarsal (Lisfranc) joint associated with sledding. Case presentation A 19-year-old male college student presented to the emergency department with a Lisfranc fracture dislocation of the foot as a result of a high-velocity sledding injury. The patient underwent an immediate open reduction and internal fixation. Conclusion Lisfranc injuries are often caused by high-velocity, high-energy traumas. Careful examination and thorough testing are required to identify the injury properly. Computed tomography imaging is often recommended to aid in diagnosis. Treatment of severe cases may require immediate open reduction and internal fixation, especially if the risk of compartment syndrome is present, followed by a period of immobilization. Complete recovery may take up to 1 year.

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Unusual presentation of Lisfranc fracture dislocation associated with high-velocity sledding injury: a case report and review of the literature

Journal of Medical Case Reports Unusual presentation of Lisfranc fracture dislocation associated with high-velocity sledding injury: a case report and review of the literature Christopher E Benejam*1 and Steven G Potaczek2 0 Department of Orthopedic Surgery, Galesburg Clinic , N Seminary St, Galesburg, IL, 61401 , USA 1 Augustana College , 38th Street, Rock Island, IL, 61201 , USA Introduction: Lisfranc fracture dislocations of the foot are rare injuries. A recent literature search revealed no reported cases of injury to the tarsometatarsal (Lisfranc) joint associated with sledding. Case presentation: A 19-year-old male college student presented to the emergency department with a Lisfranc fracture dislocation of the foot as a result of a high-velocity sledding injury. The patient underwent an immediate open reduction and internal fixation. Conclusion: Lisfranc injuries are often caused by high-velocity, high-energy traumas. Careful examination and thorough testing are required to identify the injury properly. Computed tomography imaging is often recommended to aid in diagnosis. Treatment of severe cases may require immediate open reduction and internal fixation, especially if the risk of compartment syndrome is present, followed by a period of immobilization. Complete recovery may take up to 1 year. - Introduction An unusual case of Lisfranc fracture dislocation of the foot resulting from a high-velocity sledding injury is discussed. A recent literature search revealed no reported cases of injury to the tarsometatarsal (Lisfranc) joint associated with sledding. Case presentation A healthy 19-year-old male college student presented to the emergency department with acute pain in the left foot after sustaining a sledding injury. While sledding in the sitting position and with legs extended, the plantar aspect of his left foot struck a tree limb at high speed. The pain was throbbing and did not radiate. Weight bearing was On physical examination, localized swelling and tenderness of the dorsal aspect of the midfoot prevented weightbearing or movement of the foot and ankle. Circulation and neurological examinations were normal. The skin was intact. Foot radiograph demonstrated a Lisfranc fracture dislocation (Fig. 1). A subsequent CT scan is shown (Fig. 2). This patient underwent an immediate open reduction and internal fixation of the Lisfranc fracture-dislocation. A RFiagduiorgera1ph of the left foot Radiograph of the left foot. There is lateral displacement of the first, second, and third metatarsals (tarsometatarsal or Lisfranc joint) with associated fracture of the middle cuneiform. postoperative radiograph is shown (Fig. 3). He was treated with a non-weight-bearing cast followed by a weight-bearing boot. He was advised to refrain from strenuous physical activity for 6 weeks after removal of the boot, after which time, normal physical activity was resumed. A nonsteroidal anti-inflammatory drug was prescribed for pain. The patient had only mild pain with weight-bearing at 6 months and was ambulating without difficulty; he was pain-free at 2 years. Discussion The Lisfranc joint derives its name from Jacques Lisfranc (17901847), a surgeon in Napoleon's army. Lisfranc performed amputations through the tarsometatarsal (TMT) joint to treat gangrenous injury of the foot [1]. Injuries of the Lisfranc joint are rare, representing less than 0.2% of all orthopedic traumas [2]. However, as many as 20% of Lisfranc joint injuries are missed upon initial examination [3]. The injury should always be suspected following FCiogmurpeut2ed tomography of the left foot Computed tomography of the left foot. There is disruption of the tarsometatarsal (Lisfranc) joint with associated soft tissue swelling. trauma to the foot [4]. Most commonly, Lisfranc joint sprains and fractures are caused by high-velocity traumas, such as motor vehicle and industrial accidents. Injuries can be sustained during many athletic activities. In this case, injury was caused by direct impact of the foot against a tree trunk resulting in acute plantar flexion. In patients with high-energy trauma foot injury, CT imaging is often recommended to aid in diagnosis [5]. Mild sprains to the Lisfranc joint, where there is no evidence of diastasis, may be treated by immobilization [6]. Treatment of more severe cases such as dislocations, however, usually includes open reduction and internal fixation of the joint. Cortical screw fixation is preferred to Kirschner wire fixation for these injuries [7]. The joint is secured to reduce without diastasis the lateral border of the medial cuneiform to the second metatarsal [3]. Surgery may be postponed to allow for reduction in tissue edema. However, if a risk of compartment syndrome is present, surgery should be performed immediately. After surgery, the foot is immobilized in a non-weight-bearing cast for 6 to 8 weeks, after which, the foot may be placed in an immobilizing boot with minimal weight bearing. After a (...truncated)


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Christopher E Benejam, Steven G Potaczek. Unusual presentation of Lisfranc fracture dislocation associated with high-velocity sledding injury: a case report and review of the literature, Journal of Medical Case Reports, 2008, pp. 266, 2, DOI: 10.1186/1752-1947-2-266