Lisfranc’s fractures and dislocations can be complex and a part of mixed trauma. I saw a case last week in which the patient had sustained a motorcylce injury resulting in a Lisfranc dislocation of the first and second metatarsals, fracture of the third metatarsal and fracture of the medial cuneiform. The third metatarsal was intact at the base without disruption of Lisfranc’s joint but had a mid shaft fracture.
The goal in Lisfranc fractures is to realign the normal joint architecture to avoid future arthritis. The cases are often misdiagnosed and under treated. In this case an MRI confirmed our suspicions of a disruption of Lisfranc’s ligament and a diastasis of the first and second metatarsals. This case was an excellent candidate for use of Arthrex’s new Mini TightRope System. Traditionally the medial cuneiform would be used to fixate the second metatarsal with rigid fixation. In this case where the patient had a fractured medial cuneiform with a weak medial wall, we chose to pass the TightRope from the mid-shaft 1st metatarsal to the base of the second metatarsal. This was accomplished through a 1cm incision and performed under fluoroscopy.
I saw the patient for a 2 week f/u visit yesterday for removal of the single suture. He’s doing quite well with minimal edema. He’ll be in a cast for a total of 6 weeks, non-weight bearing. I’ll transition him to a walking cast for 4 weeks to follow.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
