IS Case 614: Lesfranc fracture-dislocation

Penelope Block, MD

Imaging Sciences URMC

Imaging Sciences URMC 2011
Publication Date: 2011-12-12

History

The patient is a 16-year-old female with left lateral foot pain.

Findings

There is medial subluxation of the left fourth metatarsal in relation to the cuboid bone, with a linear oblique lucency through the proximal fourth metatarsal. There is a minimally displaced oblique fracture of the left fifth metatarsal mid-diaphysis.

Diagnosis

Lesfranc fracture-dislocation

Discussion

This is the most common dislocation of the foot, and frequently occurs in association with various types of fractures. There are two basic forms of injury: homolateral and divergent. Homolateral is dislocation of the first to the fifth metatarsal and divergent is lateral displacement of the second to the fifth metatarsals with medial or dorsal shift of the first metatarsal. Associated fractures most often occur at the base of the second metatarsal bone, but may involve other metatarsals, first or second cuneiform, or navicular bones.

In the oblique view, the medial and lateral borders of the 3rd (lateral) cuneiform should align with medial and lateral borders of 3rd metatarsal, and the medial border of 4th metatarsal should align with medial border of cuboid.

References

  1. Greenspan A. Orthopaedic Imaging: A Practical Approach. Third Edition. Lippincott Williams & Wilkins, 2000:324.
  2. There is a good discussion with normal anatomic imaging at: http://www.learningradiology.com/archives06/COW%20217-Lisfranc%20fx/lisfranccorrect.htm

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