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

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
• 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
• 3 Faciszewski T, Burks R T, Manaster B J. Subtle injuries to the Lisfranc joint.  J Bone Joint Surg [Am]. 1990;  72 1519-1522
• 4 Foster S C, Foster R R. Lisfranc's tarsometatarsal fracture-dislocation.  Radiology. 1976;  120 79-83
• 5 Goiney R C, Connell D G, Nichols D M. CT evaluation of tarsometatarsal fracture-dislocation injuries.  AJR. 1985;  159 985-990
• 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
• 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
• 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
• 9 Myerson M. Tarsometatarsal joint injuries: subtle signs hold the key.  Phys Sportsmed. 1993;  21 97-107
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 18 Trevino S G, Kodros S. Controversies in tarsometatarsal injuries.  Orthop Clin North Am. 1995;  26 229-238
• 19 Vuori J P, Aro H AT. Lisfranc joint injuries: Trauma mechanism and associated injuries.  J Trauma. 1993;  35 40-45
• 20 Wilson D W. Injuries of the tarsometatarsal joints.  J Bone Joint Surg [Br]. 1972;  54 677-686