Lisfranc Fracture Dislocation

This is a patient who presents with foot pain following a motor vehicle accident. Frontal, oblique, and lateral radiographs of the foot were obtained. The frontal radiograph demonstrates abnormal alignment of the foot with the red arrow representing a widened interspace between the first and second metatarsals. Additionally, the medial margin of the intermediate cuneiform should always be aligned with the medial margin of the second metatarsal base. In this case, the second through fifth metatarsals are dislocated medially. Additionally, the green arrow demonstrates offset of the medial cuneiform and the base of the hallux metatarsal second to medial dislocation. These findings are also nicely demonstrated on the second radiograph. The lateral radiograph demonstrates dorsal dislocation of the second and third metatarsals relative to the midfoot and hindfoot. This is demonstrated by the red arrow. These findings are consistent with a Lisfranc fracture dislocation. These is a serious injury that usually occurs in the setting of high energy trauma or diabetes. Dislocation is usually secondary to disruption of the Lisfranc ligament as well as the intermetarsal ligaments. Fractures of the bases of the metatarsal as well as cuneiform bones are commonly seen. Treatment is surgical.