Lisfranc midfoot dislocations include bone and ligament injuries to the tarsometatarsal joint complex. Rare lesion, with an incidence rate of 1 to 55,000 patients annually, 20% of injuries remain undiagnosed. Mechanisms of injury are direct and indirect, including traffic accidents and sports. Clinical signs and symptoms are: midfoot pain, inability to bear weight, leg deformity and swelling, and plantar ecchymosis. Pedal artery or deep peroneal nerve may be compromised and the compartment syndrome may occur. Radiographic incidences reveal changes and dislocations in tarsometatarsal interlining. Stress radiographs are helpful in unstable lesions. CT is used for diagnosis and preoperative planning. Lisfranc injury classifications can not determine the treatment or suggest prognosis.Nonsurgical treatment for stable injuries (<2 mm dislocation) implies immobilization for 4-6 weeks with a non-weight-bearing cast Open reduction with rigid internal fixation is indicated in cases of obvious instability (> 2 mm displacement). Medial and middle columns are fixed with 3.5 mm screws, and lateral column with Kirschner pins. Postoperative care includes early mobilization, progressive weight-bearing, and osteosynthesis material removal. Primary tarsometatarsal arthrodesis is an alternative in lesions with severe joint damage. Immediate complications are common, including neurovascular injury and compartment syndrome, and late complications are posttraumatic midfoot arthrosis, algoneurodistrofic syndrome, chronic foot pain, implant deterioration. Patients require a long rehabilitation period. The incidence of posttraumatic arthritis is high, due to damaged articular surfaces, comminuted fractures, or due to side movements, results of unstable osteosynthesis.
Keywords: Lisfranc joint complex; tarso-metatarsal dislocation; internal fixation; midfoot osteoarthritis