Lisfranc joint: the tarsometatarsal joint complex which joins the forefoot and midfoot – Forefoot: five metatarsals (M1-M5*); Midfoot: three cuneiforms (C1-C3**) and the cuboid.
Fleck sign: small bony fragment observed between the base of M1, M2 (Lisfranc space). Often associated with avulsion of the interosseous ligament at the base of M2 (Lisfranc ligament). Subtle, sensitive finding of Lisfranc injury.
Lisfranc ligament: the dorsal, interosseous, and plantar ligaments connect C1 (medial cuneiform) to M2 (2nd metatarsal base). The interosseous ligament is the most important ligament of the Lisfranc joint ligamentous complex; is most often disrupted in midfoot injuries and most commonly referred to as the ‘Lisfranc ligament‘
- * M1-M5: First through fifth metatarsals
- ** C1: Medial cuneiform; C2: Middle cuneiform; C3: Lateral cuneiform
Lisfranc amputation: removal of the forefoot at the tarsometatarsal joint complex. Lisfranc describes the ‘master stroke‘ of his operation:
Le couteau dans le dos s’appuie sur le tendon transversal du long péronier latéral, pénètre de la pointe, tranchant haut, dans l’interligne et coupe en se relevant le ligament interosseux par le coup de maître
The knife in the back rests on the transverse tendon of the long lateral peroneus, penetrates from the point, cutting high, into the space between the line and cuts the interosseous ligament by lifting it up with the master stroke
History of the Lisfranc fracture
1799 – William Hey (1736-1819) describes a method for amputation of the forefoot by removing affected metatarsal bones at the junction with the cuneiform bones [Case II, 1799. p534-537]
1815 – Lisfranc described in detail a simple and rapid method for forefoot amputation at the tarsometatarsal joint, famously performed in less than a minute – for which the un-anaesthetised patients were thankful…
1823 – Lisfranc was well aware that the operation had been performed previously and responded to his many critics:
Je n’ai jamais eu la prétention d’avoir imaginé l’amputation dans l’articulation tarso-métatarsienne: il m’appartient d’avoir le premier fait convenablement et rigoureusement l’anatomie chirurgicale de l’articulation du tarse avec le métatarse, et d’avoir décrit l’extirpation en masse de tous les métatarsiens avec assez de soin pour que l’opération soit devenue facile et prompte
I have never pretended to have invented the amputation at the tarsal-metatarsal joint: I am the first to have performed it properly and rigorously in respect to the surgical anatomy of the tarsal joint and metatarsus; and to have described the mass eradication of all the metatarsals with enough care for the operation to become quick, easy and efficient
- William Hey (1736-1819)
- Jacques Lisfranc de Saint-Martin (1787–1847)
- Lisfranc fracture-dislocations
Lisfranc was not the first to describe the forefoot amputation procedure, this is widely attributed to William Hey (1736-1819) and his operative description on Mary Stransfield. Lisfranc described and refined the disarticulation of the forefoot at the tarsometatarsal joint, and this joint has been eponymously attributed to Lisfranc.
Lisfranc described the coup de maître of his disarticulation operation being the incision of the interosseous ligament (subsequently referred to as the Lisfranc ligament)
- Hey W. Excision of the metatarsal bones. In: Practical observations in surgery. 1803: 530-537
- Lisfranc J. Nouvelle méthode opératoire pour l’amputation partielle du pied de son articulation tarsométatarsienne. methode precedee des nombreuses modifications qu’a subies celle de Chopart. 1815. [Lisfranc amputation TMJ]
- Lisfranc J. Nouvelle methode operatoire pour l’amputation partielle du pied. Archives générales de médecine. Sep 1823: III: 52-67
- Averill C. A short treatise on operative surgery, describing the principal operations as they are practised in England and France; designed for the use of students in operating on the dead body. London: Jackson, Borough. 1825
- Cassebaum WH. Lisfranc fracture-dislocations. Clin Orthop Relat Res. 1963;30:116-129
- Foster SC, Foster RR. Lisfranc’s tarsometatarsal fracture-dislocation. Radiology. 1976;120(1):79-83.
- Gupta RT, Wadhwa RP, Learch TJ, Herwick SM. Lisfranc injury: imaging findings for this important but often-missed diagnosis. Curr Probl Diagn Radiol. 2008;37(3):115-126
- Johnson A, Hill K, Ward J, Ficke J. Anatomy of the lisfranc ligament. Foot Ankle Spec. 2008;1(1):19-23.
- Hatem SF. Imaging of lisfranc injury and midfoot sprain. Radiol Clin North Am. 2008;46(6):1045-vi.
- Castro M, Melão L, Canella C, et al. Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. AJR Am J Roentgenol. 2010;195(6):W447-W455.
- Kalia V, Fishman EK, Carrino JA, Fayad LM. Epidemiology, imaging, and treatment of Lisfranc fracture-dislocations revisited. Skeletal Radiol. 2012;41(2):129-136.
- Siddiqui NA, Galizia MS, Almusa E, Omar IM. Evaluation of the tarsometatarsal joint using conventional radiography, CT, and MR imaging. Radiographics. 2014;34(2):514-531
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