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Osteosynthesis and Trauma Care 2003; 11: 134-137
DOI: 10.1055/s-2003-42315
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© Georg Thieme Verlag Stuttgart · New York

Anatomic Morphology of the Lisfranc Joint Line - Risk Factor for Fractures and Fracture Dislocations?

G. Peicha1 , P. Tesch2 , F. Fankhauser1 , G. Windisch2 , F. J. Seibert1 , W. Grechenig1
  • 1Department of Traumatology, University of Graz, Medical School, Graz, Austria
  • 2Anatomic Institute, University of Graz, Medical School, Graz, Austria
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Publication History

Publication Date:
24 September 2003 (online)

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Abstract

Aim of the study was to evaluate the anatomic morphology of the “mortise ” of the Lisfranc joint between the medial and lateral cuneiforms and to determine a risk factor for Lisfranc injuries. The following data were obtained in 33 patients with confirmed Lisfranc injuries through evaluation of conventional radiographs: A (medial depth of the mortise), B (lateral depth), C (length of the second metatarsal). Subsequently, we calculated the mean depth of the mortise, (A + B)/2, and the coefficients of the lever arm as follows: C/A, C/B, and C/mean depth. The data was compared to the data obtained in 84 cadaver feet with no pre-existing injury of the Lisfranc joint complex.

The data was statistically evaluated using Student's two-sample t-test and forward stepwise logistic regression. Medial mortise depth “A ”, and all coefficients containing “A”, showed statistically significant differences between the injured cases and the cadaveric control group. The mortise had significantly less depth in patients with confirmed Lisfranc injuries than in the control group. Stepwise logistic regression identified only depth A as a relevant risk factor for Lisfranc injuries. The odds of being a case (i. e., sustaining a fracture) are decreased by 0.52 for every 1 mm increase in the medial depth of the mortise. We conclude that the mortise in patients with injuries to the Lisfranc joint is more shallow than in the control group and that this population group is anatomically predisposed for Lisfranc fracture-dislocation injuries. The shallower the mortise the greater is the risk of injury to the Lisfranc joint.

Key words

Lisfranc joint - anatomy - joint mortise - risk of injury

References

  • 1 Aitken A P, Poulson D. Dislocation of the tarsometatarsal joint.  J Bone Joint Surg [Am]. 1963;  45 246-250
    PubMedSearch in Google Scholar
  • 2 Berg J H, Silveri C P, Harris M. Variant of the Lisfranc fracture-dislocation: A case report and review of the literature.  J Orthop Trauma. 1998;  2 366-369
    PubMedSearch in Google Scholar
  • 3 Faciszewski T, Burks R T, Manaster B J. Subtle injuries to the Lisfranc joint.  J Bone Joint Surg [Am]. 1990;  72 1519-1522
    PubMedSearch in Google Scholar
  • 4 Foster S C, Foster R R. Lisfranc's tarsometatarsal fracture-dislocation.  Radiology. 1976;  120 79-83
    PubMedSearch in Google Scholar
  • 5 Goiney R C, Connell D G, Nichols D M. CT evaluation of tarsometatarsal fracture-dislocation injuries.  AJR. 1985;  159 985-990
    PubMedSearch in Google Scholar
  • 6 Hardcastle P H, Reschauer R, Kutscha-Lissberg E, Schöffmann W. Injuries to the tarsometatarsal joint.  J Bone Joint Surg [Br]. 1982;  64 349-357
    PubMedSearch in Google Scholar
  • 7 Leenen L PH, van der Werken C. Fracture-dislocation of the tarsometatarsal joint, a combined automatical and computed tomographic study.  Injury. 1992;  23 51-55
    CrossrefPubMedSearch in Google Scholar
  • 8 Lu J, Ebrahaim N H, Skie M, Porshinsky B, Yeasting R A. Radiographic and computed tomographic evaluation of Lisfranc dislocation: A cadaver study.  Foot Ankle Int. 1997;  18 351-355
    PubMedSearch in Google Scholar
  • 9 Myerson M. Tarsometatarsal joint injuries: subtle signs hold the key.  Phys Sportsmed. 1993;  21 97-107
    PubMedSearch in Google Scholar
  • 10 Norfray F J, Geline R A, Steinberg R I, Galinski A W, Gilula L A. Subtle ties of Lisfranc fracture-dislocations.  AJR. 1981;  137 1151-1156
    PubMedSearch in Google Scholar
  • 11 Peicha G, Preidler K W, Seibert F J, Stockenhuber N, Hofer H P, Fankhauser F, Lajtai G. Acute hyperflexion trauma of the foot - A clinical comparison between conventional radiography, CT and MRI.  SOT. 1999;  22 19-26
    PubMedSearch in Google Scholar
  • 12 Potter H G, Deland J T, Gusmer P B, Carson E, Warren R F. Magnetic resonance imaging of the Lisfranc ligament of the foot.  Foot Ankle Int. 1998;  19 438-446
    CrossrefPubMedSearch in Google Scholar
  • 13 Preidler K W, Brossman J, Daenen B, Goodwin D, Schweitzer M, Resnick D. MR imaging of the tarsometatarsal joint: Analysis of eleven patients with Lisfranc dislocation.  AJR. 1996;  167 1217-1222
    PubMedSearch in Google Scholar
  • 14 Preidler K W, Peicha G, Lajtai G, Seibert F J, Fock C, Szolar D M, Raith H. Conventional radiography, CT and MR imaging in patients with hyperflexion injuries of the foot: Diagnostic accuracy in the detection of bony and ligamentous changes.  AJR. 1999;  173 1673-1677
    PubMedSearch in Google Scholar
  • 15 Preidler K W, Wang Y C, Brossman J, Trudell D, Daenen B, Resnick D. MR imaging of the tarsometatarsal joint: anatomic considerations.  Radiology. 1996;  199 733-736
    PubMedSearch in Google Scholar
  • 16 Sarafian S K. Syndesmology. In: Sarafian SK (ed). Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional. 2nd ed. Philadelphia (PA), J.B. Lippincott Company 1983; 159-217
  • 17 Shapiro M S, Wascher D C, Finerman G AM. Rupture of Lisfranc’s ligament in athletes.  Am J Sports Med. 1994;  22 687-691
    PubMedSearch in Google Scholar
  • 18 Trevino S G, Kodros S. Controversies in tarsometatarsal injuries.  Orthop Clin North Am. 1995;  26 229-238
    PubMedSearch in Google Scholar
  • 19 Vuori J P, Aro H AT. Lisfranc joint injuries: Trauma mechanism and associated injuries.  J Trauma. 1993;  35 40-45
    CrossrefPubMedSearch in Google Scholar
  • 20 Wilson D W. Injuries of the tarsometatarsal joints.  J Bone Joint Surg [Br]. 1972;  54 677-686
    PubMedSearch in Google Scholar

Univ.-Doz. Dr. G. Peicha

University of Graz, Medical School · Department of Traumatology

Auenbruggerplatz 7 a

8036 Graz

Austria

Phone: +43/3 16 38 58 12 71

Fax: +43/31 63 85 35 82

Email: gerolf.peicha@kfunigraz.ac.at