Lisfranc's fracture dislocation is one of the worst injuries that can happen in the foot. The findings are subtle, and is easily missed by the in-experienced, and the recovery can be long and sometimes un-predictable.
Though one needs to have a high index of suspicion in crush injuries of the foot, it can occur with simple trauma too. Seemingly normal x-rays with swelling in the foot, that is out of proportion should also raise the index of suspicion.
What actually happens ?
There are several joints in the foot, but this injury occurs at the Tarso-metatarsal joint complex, involving the metatarsals and the cuneiform+cuboid bones. Of importance here is the Lisfranc ligament, which is considered to be the keystone that confers stability to this joint complex.
The disruption this ligament, leads to instability of bones, needing stabilisation of the joints with surgical fixation.
Initial assessment
After a thorough clinical assessment, radiological assessment involves getting x-rays of both feet, and CT scans. The patient is asked to keep their leg elevated, with regular icing to minimise swelling.
Surgery
It first involves an examination under Anaesthesia, where the different components of the joint complex are stressed to check for stability, under the Image Intensifier (X-ray in the operation theatre). After establishing the instability pattern, appropriate incisions are made, with careful dissection to avoid tissue trauma, to expose the joints, and they are reduced carefully and stabilised with screws. Plates, K-wires or memory staples may also be used. Adequacy of fixation is confirmed with x-rays. The incisions are closed, and dressings applied.
Post-operative period
The leg is elevated to keep the swelling down, with regular icing. The patient is mobilised non-weight bearing for atleast a couple of months. Metal work may have to be removed, before normal mobilisation is initiated.
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