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.
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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)