Trauma to the Lisfranc joint

Background: Tarsometatarsal (Lisfranc) joint injuries encompass a spectrum from ligamentous sprains to high-energy comminuted fractures. Although these injuries represent only 0.1–0.4% of all fractures, they are frequently misdiagnosed, with approximately 20% of isolated ligamentous instabilities overlooked during initial evaluation. Inadequate or delayed management often leads to chronic pain, functional limitations, and secondary degenerative changes.

Objective: This review aims to synthesize the anatomical principles, diagnostic modalities, and therapeutic strategies for Lisfranc injuries to facilitate early recognition and optimize surgical or conservative outcomes.

Key Points: Clinical diagnosis is supported by findings of plantar ecchymosis and pain during midfoot provocation tests. While weight-bearing radiographs are necessary to identify subtle instability, computed tomography is the preferred modality for evaluating complex osseous morphology. Magnetic resonance imaging provides high sensitivity for assessing ligamentous disruption. Treatment selection is guided by the Quenu and Kuss or Myerson classification systems. Conservative management, involving non-weight-bearing immobilization for 6–8 weeks, is indicated only for stable injuries with displacement under 2 mm. Unstable or displaced injuries require surgical intervention to achieve anatomical reduction. Open reduction and internal fixation using screws or Kirschner wires remains the standard; however, primary arthrodesis is increasingly utilized for purely ligamentous injuries due to superior outcomes compared to fixation. Post-traumatic osteoarthritis remains a frequent complication, occurring in up to 80% of cases.

Conclusion: Precise anatomical restoration is the primary determinant of functional recovery in Lisfranc injuries. Early surgical stabilization is essential for unstable patterns, while primary arthrodesis should be considered for severe ligamentous disruptions to minimize long-term morbidity.