MIDFOOT INJURIES LISFRANCS/DISLOCATION

Question 1

T/F, plantar and interosseous ligaments are stronger than dorsal ligaments?

Answer 1

T

Question 2

forceful abduction/dorsiflexion of the forefoot on the tarsus results in fx/dislocation of metatarsals and possible shear/crush fx of the cuboid, seen in equestrian accidents and MVAs. What is this called?

Answer 2

twisting

Question 3

clinical exam findings of lisfranc/dislocation?

Answer 3

mid foot pain
inability to bear weight
tenderness with palpation
plantar ecchymosis
pronation-abduction test

*not guitar string signs

Question 4

normal space between 1st and 2nd metatarsal is how many mm?

Answer 4

1.3 mm

Question 5

MRI evaluation?

Answer 5

clear ID of lisfrancs ligament

personal choice of Dr. Ehredt

recommended for subtle injuries

Question 6

who classified this?

classified athletic mid foot injuries into three groups based on clinical findings, weight bearing radiographs, and bone scintigraphy?

Answer 6

Nunley and Vertullo

Question 7

why do we not fuse 4th and 5th TMTJ?

Answer 7

because they are necessary for terrain adaptation

Question 8

tx goals for maintenance of reduction?

i.e football player asked when hardware could come out and what would we tell him

Answer 8

at least 9-12 months, hardware removal

Question 9

hardware choices for ORIF?

Answer 9

cortical screws* no lagging across the joint
bridge plating
k-wires

Question 10

timing of surgery based on?

Answer 10

predicated on resolution of swelling and when the skin begins to wrinkle

severe injuries may require 3-4 weeks of bulky jones splinting and elevation

grossly displaced injuries will need to be staged with initial CREF followed by definitive procedure of arthrodesis