Lisfranc Injury - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim's animated educational video describing Lisfranc injury.
Lisfranc injury is an important topic. Lisfranc injury indicates disruption between the base of the 2nd metatarsal and the medial cuneiform. Lisfranc injuries are a spectrum of injuries of the tarsometatarsal joints. It could be due to apparent sprain, obvious injury or severe dislocation.
Diagnosis is missed in about 25-30% of cases especially in multiple trauma patients. A high index of suspicion is needed to prevent progression of the foot deformity, chronic pain and dysfunction. May need weight bearing films for diagnosis of Lisfranc injury.
Lisfranc injury may be associated with compartment syndrome.
Lisfranc injury could be purely ligamentous or can be associated with fractures. ORIF is better in cases of fractures. Arthrodesis is better in cases of purely ligamentous injury. In general, ligamentous injury does worse than fractures.
The Lisfranc ligament is a large oblique ligament that extends from the plantar aspect of the medial cuneiform to the base of the second metatarsal. The Lisfranc ligament stabilizes the 2nd metatarsal and maintains the midfoot arch. Osseous stability is provided by the roman atch of the metatarsal and the recessed keystone of the 2nd metatarsal base.
Tarsometatarsal joint complex is divided into three units:
•Medial: 1st tarsometatarsal joints- first metatarsal joint- 6 degrees mobility.
•Middle: 2nd & 3rd tarsometatarsal joints-rigid
•Lateral: 4th &5th tarsometatarsal joints - mobile (this is why you do not fuse the 4th & 5th tarsometatarsal joints).
The dorsalis pedis artery and the deep peroneal nerve both run between the first and second metatarsal bases.
Mechanism of injury:
•Direct injuries: plantar displacement is more common.
•Indirect injuries: more common than direct injuries. Results from axial loading or twisting on a plantar flexed midfoot. Dorsal displacement of the 2nd metatarsal is more common. Check the aligment of the dorsum of the 2nd metatarsal with the middle cuneiform.
Associated fractures
Tarsal fracture, especially a cuboid fracture.
“Nutcracker” fracture
•Results from twisting injury causing forceful abduction of the forefoot.
•Fracture of base of the 2nd metatarsal and compression fracture of the cuboid.
Classification of Lisfranc injuries
Lisfranc classifications are not useful in deciding the treatment or the prognosis of injury. Severe injuries are obvious, easily diagnosed and may develop compartment syndrome of the foot. Injuries with minimal displacement could be missed and they will need surgery regardless of the classification. Arthritis may develop even with minimal displacement.
In general there is three patterns of injury based on commonly observed patterns:
1.Total incongruity: all five metatarsals are displaced in the same direction. Total incongruity occurs lateral or medial, with lateral being more common.
2.Partial incongruity: one or two metatarsal displaced from the others.
3.Divergent: lateral displacement of the lesser metatarsals with medial displacement of the first metatarsal.
The one thing all these injuries have in common is disruption of the tarsometatarsal joint complex.
Diagnosis
•Patient has severe pain in the midfoot and is unable to bear weight
•There may be some swelling in the midfoot dorsally.
•Plantar bruising may be present especially medially. Plantar ecchymosis is a classic clinical sign of potential lisfranc injury.
•Tenderness over the tarsometatarsal joint.
•Check the skin condition and rule out compartment syndrome.
•Check the neurovascular status of the foot.
•Weight-bearing standing x-rays with comparison views if x-rays are normal and if the physician clinically suspects a lisfranc injury,
•Another alternative is to get physician assisted midfoot stress radiograph.
Treatment
Cast: dorsal sprain and no instability: patient can be treated with non-weight bearing cast for 6 weeks an return to activity gradually.
Surgery: for instability: ORIF with cortical screws if there is bony fractures. When you do ORIF- need anatomic reduction. Hardware removal between 5-6 months.
Arthrodesis if the injury is purely ligamentous. Healing of the ligaments is less reliable than bony healing. Arthrodesis is also done in old injuries if there is delay in treatment for if there is failure of open reduction and internal fixation of Lisfranc injury. Midfoot arthrodesis is also used for chronic lisfranc injury that leads to severe midfoot arthritis with progressive arch collapse and midfoot abduction.
Fusion of the medial and middle column: 1st , 2nd and 3rd tarsometatarsal joints. Do not fuse the lateral column. Lateral column- do reduction and stabilization by k-wire fixation.
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[@karladriannedeguzman]

Who's here after Chet Holmgren's injury?

[@GreescobarGamble]

Lmao 🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣🤣 ayyyeoooooooooooooo broooo no bs tf

[@lifeisgood9449]

Lol got me

[@carlosjoelgarcia3200]

Great review of the the lower extremities. Thank you for putting these videos together. Very concise and accurate.

[@robyndaniels1381]

All you need in terms of A& P info to understand this injury and it's sequelae. Clear descriptions with illustrative diagrams and radiographs. A master-class that even non-medical people can understand. Thank you. I am a nurse with one of these nasty and serious injuries. This helped enormously with my understanding of what I'm up against and with participation in care and healing. Thanks again. x

[@carinage8700]

I hurt myself several months ago and now I have a better understanding about the injury. you are very helpful, thank you

[@A2mand2H]

Best source of information I've found on Lisfranc!

[@ortholad853]

Amazing. Excellent explanation.

[@themrdiamondmanx]

Thank you for this i am a highscool football player who sufferd this in a game great explination and is very apreciated

[@mosheeeer]

thanks Dr.Nabil

[@dpdwijesinghe1183]

Thank you for the excellent presentation

[@ha5mth]

This guy is a legend

[@redamasarani]

Thank you doc for all the knowledge you share

[@cephassatsi7480]

You were very helpful, thank you for this lecture

[@walzaher]

Thank you very much, your videos are amazing!

[@eduesuagaita]

Excellent!

[@conarybk]

Thank you so much for this video, just diagnosed with a lisfranc ligament sprain after an MRI and it been hard to find information on a sprain without fractures or dislocations. This really cleared things up for me. Thank you!

[@jfitness432]

How long was the rehab and how are you doing tkdau

[@andrearogers3780]

Thank-you, the videos are very clear. I'm a physio and worry about missing an injury like this. I feel I understand what to look for now.

[@withouthands]

Amazing concise and clear presentation of a big topic!

[@ajdaturkey]

Thank you!! Great information

[@stanleychukwuemekaokafor342]

Very helpful, thanks.

[@nixier998]

Excellent presentation. Wish I had found this immediately after my lisfrac injury on March 2ne 2018. This was the best information I found. Covered every question I had.

[@IWantToMature85]

Nixie R I dislocated my kneecap a day before that. Hopefully you’re better 😊!

[@Mu5tyLaghmani]

I'm going through an operation tomorrow but I hate hardware going into my bones

[@TrolllaTime]

Nixie R How long did it take you to heal? And was it a ligament sprain or fracture or?

[@javierteran6693]

Thanks teacher, so much ilustrative and didactic.

[@asifalam1447]

Thank you very much

[@ajdaturkey]

Just had my MRI today…. X-rays we’re clear of bone fractures. Hoping the MRI shows no indication of ligament issues 🙏 your information is the best I’ve seen. Thanks

[@govidrajanm2511]

Great very useful information for all of us Dr. thank you lots...

[@mohsinishfaq2554]

I put a 👍 on your videos even before watching them, because I know they're the best 😍

[@satyaprasad7218]

Same here

[@raminarabnejad3741]

thank you sir

[@elgilany11]

Thanks That was realy helpful

[@user-xd6nc4gw7m]

helpful video Thank you very much

[@nikes365]

HEAL QUICK ALSHON, GODSPEED!

[@believetheresgoodintheworl4792]

Thank you very much! I have a lizfranc ligament rupture and multiple fractures throughout my metatarsals this video explains a lot. I wont be going for surgery though, hoping to have a successful natural recovery.

[@jw9567]

Please, please reconsider having surgery. If you don't have it, you may have serious complications and disability later in life. If your bones are not in the correct position while your body heals it could cause a lot of problems for you. I wish you all the best for your recovery whatever you decide

[@marymarshall5134]

Very very helpful and your explanations are so clear. I wish my orthopaedic surgeon had explained more and been more holistic in his approach. He never explained half of what you have in a half hour appointment that cost a lot of money. Hmmm still unclear as to what my true prognosis is.

[@privateprivate5302]

Now I think I know too much and am a bit worried 😟I hit a deer and escaped with only a broken foot...official diagnosis:lisfranc dislocation. But I am alive and well and conscious and I thank God. I can do this Lisfranc thing. Hoorah

[@Nk-gi7de]

i ' m so appreciate Nabil you are really good. i hope i Meet you one day

[@regtait553]

thank you for explaining my injury...I was in a cast for 6 weeks and now started a moon boot - non weight-bearing for a further 5 weeks. I had CT scans and weight bearing x-rays. Radiologist said my surgeon is the only one in the hospital to ask for weight bearing x-rays. I guess I am lucky with the care given.

[@Mu5tyLaghmani]

I'm going through an operation tomorrow, I have been told that internal fixation is required but I hope they don't insert screws in my bone

[@adnanhassan4712]

@@Mu5tyLaghmani hello can I ask u about our surgery

[@Mu5tyLaghmani]

@@adnanhassan4712 You mean my surgery, twice I left the surgery theater but it has been 6 months it has not healed by itself, I will have to have the operation.

[@adnanhassan4712]

@@Mu5tyLaghmani my metatarsal 2 have fractured from five years dr advise me for operation and they says we will remove this bone and will replace with another which we will take from body

[@Mu5tyLaghmani]

@@adnanhassan4712 Bro I didn't have any fracture this is one of the reason I could avoid operation otherwise they would've operated on me right away, the fact that you left it for 5yrs is unbelievable, 1st 2nd 3rd metatarsal have been widened more gap than the normal, so they told me that they will do internal fixation using using metal and screws.

[@Ben-hb1dg]

Thank you for this video! Instead of arhtrodesis can a surgeon opt to use the arthrex internal brace?

[@stephencoombs1785]

very good but didnt mention having plates fitted and outcome off this

[@sunilvaidya6653]

We have got plaster for 12 days and removed it and have used ankle binder is that ok.dr.

[@user-gn6rz2xp1q]

دكتور عسل❤

[@Mafr0]

Travis Barker on the Joe Rogan Experience brought me here. He had this injury. Ouch!

[@shorty808100]

I went to a podiatrist with this kind of injury I had already been to a previous podiatrist where we found a 4-5mm crack where that little ligament is, when we were doing x-rays at the second place o kept telling the nurse we need to do one with me bearing weight on my foot she argued with me and wouldn’t do it

[@user-py3tx9qr3t]

So subtle and so big consequences...

[@LibinThomasManathara]

Sir, Kindly consider a video on missed fractures in the trauma setting, I think valgus impacted neck of femur, combined neck and shaft of femur fractures, this Lisfranc injury, DeQuervian injury, etc.. Sorry, if you have already posted such a video. Thank You

[@emilnenov4084]

It was very helpful but now im more scared about it I just got the surgery last week

[@m.taylor]

I had a chip fracture on the superior anterior medial cuneiform along with multiple fractures on the metatarsals, but they did not mention on CT scan whether the chip fracture was accompanied by liganent tear. Do followup xrays show whether the chip fracture has fused back properly to the main bone?

[@throictainted8136]

I had a lisfranc fracture multiple fractures about 5 to be exact... they didnt catch it on time due to the inflammation being so severe. If you dont treat a lisfranc before the 10 day mark... it's a permanent disability... I spent 5 months in a cast and was supposed to try and get a plate and 19 pins and needles. Due to covid it got pushed back and now they told me the surgery would be pointless as it will make it worse.. so I'm screwed

[@cieroboy4008]

chet holgrem's injury

[@loverofbeautifulthings]

I had a ligamentous Lisfranc injury three months ago from my horse stepping on my foot in an accident. I am using red light therapy in conjunction with my podiatrist's orders. Would love to hear from anyone who has had success with RLT in the healing and avoiding of arthritis. 💗

[@cw5118]

A horse stepped on my foot over a year ago. Bones healed... tried to walk it off for 2 months then x rays after it healed. Podiatrist said lisfranc crush injury to ligaments and nerves. Been taking high doses of 3 kinds of digestive enzymes for past 2-3 months and swelling finally gone down. Lost 30 lbs since I’ve been on crutches (since last November). The last 20 lbs lost using the enzymes. Also using near and far infrared at home. Not long enough to say how it’s working. Helps with circulation tho. Hemp cbd also has been helping with essentials oils. Not having any surgery. Been a long road but I’m determined to heal naturally. Good luck!

[@loverofbeautifulthings]

@@cw5118 Wow, we must have had our injuries around the same time (mine was August of 2020). Do you mind telling me what digestive enzymes you're taking? (and why they help with the swelling?) Thank you!

[@cw5118]

@@loverofbeautifulthings I don’t fully understand why enzymes are anti-inflammatory but they are. Optimal is one of the product names and Chronic & Digestion are the two I am taking. 2 caps (each) prior to each meal. But the other enzyme product that took the swelling down is from PuraDyme called Purazyme and I’m taking 5 caps 2x’s daily, 1 hour prior or 2 hours after large meals. The other enzymes helped me drop another 20 lbs. I had lost 10 pounds a year ago in the first week because I needed to be lighter to help with getting around easier on crutches and it helped. I’m 5’ 1” and was around 143 lbs a year ago. I am now at my high school weight, 112 and I’m 52 years old! 😃

[@loverofbeautifulthings]

@@cw5118 Thank you so much for the information. And that is awesome, congrats on getting back to your high school weight!

[@deadLEE15]

Can you tell me how the light therapy went? One of my questions i've been looking for is if it works on purely mild ligamentous lisfranc injuries. Thanks!

[@gamersunite7968]

I go for surgery for my lisfranc on the 16th of this month and I also have a fracture of my 3rd metatarsal and a comminuted 4th. I have the option for fusion or ORIF.

[@bahubalisinghsangam8830]

Hey, How r u Now u r able to walk properly, please share your experience here, its can be helpful for me...

[@gamersunite7968]

@@bahubalisinghsangam8830 I’m starting to walk without support now and have been doing so for about 3-4 weeks now. There is some pain but is manageable with tylenol and rest. Just need to take it easy and be aware of high impact activities.

[@bahubalisinghsangam8830]

@@gamersunite7968 Good, U able to manage you on satires..

[@gamersunite7968]

@@bahubalisinghsangam8830 hm? I’m sorry, I don’t understand what you were asking.

[@bahubalisinghsangam8830]

@@gamersunite7968 I mean u r able to climb on ladders

[@anthonyfasano3456]

Can someone help me. I have 6 screws in my foot and my bones were fused together. And i have rods in my foot that have to come out. My foot was broke in half.

[@ddollarz567]

How you doing ? How long it took before you could drive ?

[@anthonyfasano3456]

Please help. Im scared that i have infection my foots hot and the swelling came back. Went to hospital and they said there no infection the nures said it was infected and the doctor said its not. And my foot is hurting.

[@matt4176]

Anthony Fasano infection? maybe ask doctor for antibiotics? maybe get an x ray to see if your bones are displaced, maybe you have a fracture, and maybe you need surgery? get another doctors opinion of it. sorry for your pain, feel better

[@anthonyfasano3456]

@@matt4176 ty. It all turned around for me.

[@ddollarz567]

@@anthonyfasano3456 how you did with your injury did you had an infection ? How long before you could drive ?

[@40kgtwink44]

I have 7 screws in my foot and the doctor said that I could take my first steps after 3 months. Does anyone here had this injury? How good is the recovery? Is there any pain?

[@ddollarz567]

How you recovery going?

[@40kgtwink44]

@@ddollarz567 thank god everything is going good. I can walk a little bit with my boot on.

[@ddollarz567]

@@40kgtwink44 I’m glad to hear that thank god , how long before you could drive a car?

[@40kgtwink44]

@@ddollarz567 im still in a boot so it's dangerous to drive a car but it's not impossible. In some weeks o will be able to drive again

[@bahubalisinghsangam8830]

Hey how r u now

[@RocketRep0rt]

Chet missing the whole season cause of this

[@XxxHypnoticONExxX]

OKC fans pumping up this video's numbers. 😆

[@jacksulivan6454]

Who’s all here because of cam newton? 👇🏾

[@kaitlinweible7723]

I wish that was the first time I heard about it 🤦‍♀️ 2014 injury, recovery still pending

[@raniebulaquina]

IM HERE BECAUSE OF CHET HOLMGREN (NBA).

[@mikejano5250]

Travis Etienne brought me here

[@skythunder2601]

🌴🌹♥️🌷

[@pamanichristian5593]

Holmgren brought me here