Lisfranc fracture-dislocation: A case report

The tarsometatarsal joint is an anatomic area where a wide spectrum of injuries can occur. Regarding the damage mechanism, indirect injuries are more frequent and usually occur during bending or twisting movements applied to the midfoot. This mechanism is very common in sports but also possible in household accidents and falls. Patients can present with pain localized in the midfoot which can include swelling and functional disability to bear weight after trauma. Due to the diversity of injuries, there is no single evidence-based policy for treating all Lisfranc injuries in a similar manner. The goal of initial presentation of these injuries is directed towards improving the overall alignment of the foot. The diagnosis can be made by evaluating anteroposterior, lateral and 30° oblique X-rays of the foot bearing weight because in some cases the instability will only be evident after load is placed on the feet; minor displacement and smaller fractures may only be detected with CT or MRI. The diagnosis can be difficult and it is missed in up to one third of cases. It is important to recognize these injuries early and start treatment promptly because delayed treatment can lead to chronic pain, functional disability and, in some cases, to medical liability. This case illustrates a traumatic Lisfranc injury misdiagnosed at initial evaluation, which led to chronic pain and permanent functional disability. The aim of this paper is to raise awareness of this rare injury for orthopedic surgeons to avoid cases of malpractice claims and medical liability.