Ver el código de «Lisfranc injury»

==Background==
[[File:Foot_Bones.jpg|thumb|Bones of the foot.]]
*Lisfranc Injury = any fracture or dislocation of the tarsal-metatarsal joint
*Lisfranc ligament attaches 2nd metatarsal to medial cuneiform
**2nd metatarsal is held in mortice created by the three cuneiform bones
***Injury to 2nd metatarsal often results in dislocation of the other MTs 
*Dorsalis pedis may be injured in severe dislocation

===Epidemiology===
*20% are missed on first presentation to ED
*Up to 1/3 of inuries are from minor slip/fall

==Clinical Features==
*Inability to bear weight (especially on tiptoe)
*Tenderness over tarsometatarsal region
*Pain with pronation and passive abduction of the midfoot
*Ecchymosis of plantar section of midfoot is highly suggestive

==Differential Diagnosis==
{{Foot and toe fractures DDX}}

==Evaluation==
[[File:Lisfranc.jpg|thumb|Lisfranc injury]]
''Fracture of base of second metatarsal is pathognomonic''
*AP
**Medial margin of 2nd metatarsal base does not align with medial margin of 2nd cuneiform
**Bony displacement 1mm or greater between bases of first and second metatarsals is considered unstable
*Oblique
**Medial margin of 3rd metatarsal does not align with medial margin of 3rd cuneiform
*Lateral
**2nd metatarsal is higher than middle cuneiform (step-off)

==Treatment & Disposition==
''Most Lisfranc fractures require eventual surgery''
{{General Fracture Management}}

===Specific Management===
*Sprains and non-displaced fractures:
**Non-weightbearing splint with ortho follow up (most managed with cast x 6 weeks)
**[[Posterior Ankle Splint]]
*Displaced fractures:
**Emergent ortho consult
**When diagnosed appropriately, patients who undergo open reduction and internal fixation of fractures have superior outcomes to those with purely ligamentous injury.<ref>Sherief, T et al. Lisfranc injury: How frequently does it get missed? And how can we improve?  Injury: International Journal of the Care of the Injured 2007: 34; 856-860.  PMID: 17214988</ref>

==Complications==
*[[Compartment syndrome]]

==See Also==
*[[Foot and toe fractures]]

==References==
<references/>
[[Category:Orthopedics]]