Lisfranc Injuries: Case Presentation
Ryan Will MDOlympia Orthopaedic Associates
Olympia, WA
Disclosures
• I have nothing to disclose regarding commercial support
My Basic Approach
• 2 Roman Arches – transverse and longitudinal
• Requires Absolute Stability and Reduction
• Joints should not move
• I don’t typically fuse (it’s really hard)
Role of Gastrocnemius
• Ask pt’s about Hx of plantar fasciitis, flat feet, cavus feet, multiple chronic ankle sprains, bunions, calf cramps• Need to examine the
contralateral foot as well• 1st ray hypermobility, Silverskiold
test
• All of above pathology related to pre-existing gastroc contracture
Case – 65 yo female
• 1 week before consultation, pt was at doctor’s when she twisted and felt a pop in her foot. Unable to bear weight since. Admitted for other reasons• Complex PMH – currently with open ostomy for previous bowel
obstruction, pending reversal, COPD, fibromyalgia, might need TPN soon• States she has “flat feet” • Foot with expected swelling, extensive plantar ecchymosis• Contralateral foot with 1st ray hypermobility and positive Silverskiold
test
Initial Images
Steps I Take
• Gastroc recession vs Achilles perc lengthening (take the pressure off)• Make dual dorsal approach• Examine the Intercunieform joint and stabilize• Reduce 2nd TMT joint FIRST (keystone in building the arch)• Reduce 3rd TMT next then 1st TMT LAST• Hold each reduction with K-wires• Exchange sequentially for screws or plates depending on
comminution
Intraoperative Images
Intraoperative Images Cont
Intraoperative Images Cont
Follow Up Radiograph 6 months
Final Follow Up
• All wounds healed uneventfully• Pt able to ambulate
independently at 6 months• Denies much pain• No further surgery needed in
this case
• Final thoughts
• Look at the opposite foot• Think about the gastroc• Usually needs more than less
fixation• Fusion not normally needed