Evidence brief
Lisfranc Injuries: Diagnosis and Treatment
Anatomic reduction critical for outcomes
Even 2mm displacement leads to arthritis
Weight-bearing radiographs essential for diagnosis
Primary arthrodesis may be considered for severe injuries
High rate of post-traumatic arthritis regardless of treatment
Lisfranc injuries require high index of suspicion, anatomic reduction, and careful follow-up. Even well-treated injuries have significant arthritis rates.
Key diagnostic findings: fleck sign (Lisfranc ligament avulsion), >2mm diastasis C1-M2, weight-bearing stress views. Myerson classification. Treatment: anatomic ORIF or primary arthrodesis. Discuss bridging plates vs screws. Expect arthritis - counsel patients.
Myerson MS et al. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle. 1986;6(5):225-242.
Level III
Retrospective comparative study or case-control study