Which is a fracture-dislocation of the tarsometatarsal joint?

Which is a fracture-dislocation of the tarsometatarsal joint?

• A. Jones
• B. Tillaux
• C. March
• D. Lisfranc

Answer: (D)

This is describing a Lisfranc injury, where the tarsometatarsal joints between the bases of the metatarsals and the underlying tarsal bones are fractured and/or dislocated. The Lisfranc complex stabilizes the midfoot to the forefoot, so when these joints are disrupted, the alignment between the forefoot and midfoot is lost, producing a fracture-dislocation pattern. Mechanism often involves an axial load on a foot that is plantarflexed, such as a crush injury or a fall, and injuries can be purely ligamentous or include fractures of the metatarsal bases or tarsal bones. Clinically, there may be midfoot pain, swelling, and difficulty bearing weight, and radiographs can show dorsal dislocation or diastasis between the bases of the first and second metatarsals, sometimes with a small fleck sign representing an avulsion from the Lisfranc ligament. For comparison, a Jones fracture is an avulsion injury at the base of the fifth metatarsal, not the tarsometatarsal joints; a Tillaux fracture is a distal tibial epiphyseal fracture in adolescents; a March fracture is a stress fracture of the metatarsal shaft, usually the second. The pattern described here specifically matches a Lisfranc injury.

This is describing a Lisfranc injury, where the tarsometatarsal joints between the bases of the metatarsals and the underlying tarsal bones are fractured and/or dislocated. The Lisfranc complex stabilizes the midfoot to the forefoot, so when these joints are disrupted, the alignment between the forefoot and midfoot is lost, producing a fracture-dislocation pattern.

Mechanism often involves an axial load on a foot that is plantarflexed, such as a crush injury or a fall, and injuries can be purely ligamentous or include fractures of the metatarsal bases or tarsal bones. Clinically, there may be midfoot pain, swelling, and difficulty bearing weight, and radiographs can show dorsal dislocation or diastasis between the bases of the first and second metatarsals, sometimes with a small fleck sign representing an avulsion from the Lisfranc ligament.

For comparison, a Jones fracture is an avulsion injury at the base of the fifth metatarsal, not the tarsometatarsal joints; a Tillaux fracture is a distal tibial epiphyseal fracture in adolescents; a March fracture is a stress fracture of the metatarsal shaft, usually the second. The pattern described here specifically matches a Lisfranc injury.