Lisfranc fracture

Definitions

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

Lisfranc 1823

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

Lisfranc 1823


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…

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 inter-osseux par le coup de maître

Malgré la supériorité vainement contestée de la méthode Chopart, les practiciens ont senti comme moi la nécessité de conserver plus de longueur au moignon.

Outre les muscles et les tendons qui fortifient la contiguité tarso-métatarsienne, elle possède des ligamens qui lui sont propres: l’articulation du second os du métatarse avec les cunéiformes en a trois pour sa face dorsale et trois pour la plantaire…

Telle que nous venons de la décrire, l’amputation partielle du pied dans l’articulation tarso-métatarsienne est terminée en moins d’une minute; or, il nous semble qu’on doit la préférer à celle de Chopart toutes les fois que le désordre des parties le permettre. 

Lisfranc, 1815

The knife in the back rests on the transverse tendon of the long lateral peroneus, penetrates from the point, sharp high, in the space and cut while raising the interosseous ligament with the masterstroke

Despite the vainly contested superiority of the Chopart method, practicians such as I have felt the need to conserve more length in the stump.

Aside from the muscles and tendons which fortify the tarso-metatarsal joint, it also possesses ligaments of it’s own: the articulation of the second metatarsal bone with the cuneiforms has three (ligaments) on its dorsal and three on its plantar surface…

Such as we have described it, the partial amputation of the foot in the tarso-metatarsal articulation is completed in less than one minute; thus it would seem that one should prefer it to the Chopart method, whenever the derangement of the parts would permit.

Lisfranc, 1815

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

Lisfranc 1823

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

Lisfranc 1823

Lisfranc’s description of amputation through the tarsal-metatarsal joints requires several pages to describe it, but it took only 1 minute for him to perform it — not too short a time for the unanesthetized patient

Cassebaum WH, 1963

Associated Persons

Alternative names
  • Lisfranc fracture-dislocations

Controversies

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)


References

Historical references

Article reviews


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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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