MyPACS.net: Radiology Teaching Files > Case 141929

never visited LISFRANC HIGH GRADE SPRAIN
Contributed by: Kristina Kjeldsberg, Radiologist, University of California, San Diego, California, USA.
Patient: 36 year old female
History: fx of right base of 3rd metatarsal 2 wks prior with diffuse tenderness of lisfranc joint.
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Fig. 1: The base of the second metatarsal bone is recessed, has multiple articulations with the cuneiform bones, and forms the keystone of the tarsometatarsal bony arch. The intermetatarsal ligaments connect the second through fifth metatarsal bones; however, there are no intermetatarsal ligaments between the first and second metatarsal bones. The largest ligament of the tarsometatarsal articulation, the Lisfranc ligament, arises from the lateral surface of the medial cuneiform bone and runs obliquely plantar and lateral to insert on the base of the second metatarsal bone.

Fig. 2: normal T1 Lisfranc ligament

Fig. 3: normal T2 Lisfranc ligament

Fig. 4

Fig. 5

Fig. 6: Comminuted base of 3rd MT fx with intraarticular extension.

Fig. 7

Fig. 8

Fig. 9: Note dorsal subluxation at TMT joint.

Fig. 10: Convergent homolateral fracture dislocation of the TMT joint.

Fig. 11: Convergent homolateral fracture dislocation of the TMT joint.
Findings:

Comminuted intraarticular base of 3rd MT fracture.
High grade sprain of Lisfranc ligament which appears ill-defined, thickened, with increased signal.
Associated BM edema involving bases of 1-5 metatarsals, 1-3rd cunieforms, and cuboid.

Diagnosis: As above.
Discussion:

The Lisfranc joint is a complex skeletal and capsuloligamentous structure that provides significant stability while maintaining the transverse arch of the foot.

Delayed treatment or missed diagnosis of these injuries can lead to significant complications with TMT premature arthritis.

References:

Am J Sports Med. 2002 Nov-Dec;30(6):871-8. Classification, investigation, and management of midfoot sprains: Lisfranc injuries in the athlete.

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Additional Details:

Case Number: 141929Last Updated: 09-11-2003
Anatomy: Skeletal System   Pathology: Trauma
Modality: MRExam Date: 09-05-2003Access Level: Readable by all users

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