From the Guidelines
A homolateral Lisfranc injury is a severe type of foot trauma characterized by the displacement of all five metatarsal bones in the same direction, either medially or laterally, away from the midline of the foot, and requires prompt diagnosis and treatment to prevent chronic pain, post-traumatic arthritis, and significant disability. This injury affects the Lisfranc joint complex, which connects the midfoot to the forefoot at the tarsometatarsal joints. Homolateral Lisfranc injuries typically result from high-energy trauma such as motor vehicle accidents, falls from height, or crushing injuries.
Key Characteristics of Homolateral Lisfranc Injuries
- Displacement of all five metatarsal bones in the same direction
- Medial or lateral displacement away from the midline of the foot
- High-energy trauma as a common cause
- Affects the Lisfranc joint complex
Diagnosis and Treatment
Diagnosis requires careful clinical examination looking for midfoot pain, swelling, bruising on the plantar aspect of the foot, and inability to bear weight, along with appropriate imaging including weight-bearing radiographs, CT scans, or MRI, as recommended by the American College of Radiology 1. Treatment usually requires surgical intervention with open reduction and internal fixation to restore proper alignment of the displaced metatarsals, followed by a period of non-weight bearing for 6-8 weeks and gradual rehabilitation.
Importance of Prompt Treatment
Without proper treatment, these injuries can lead to chronic pain, post-traumatic arthritis, and significant disability. The homolateral pattern is less common than divergent Lisfranc injuries (where metatarsals displace in different directions) but represents a more severe injury pattern with potentially worse outcomes. CT scans are particularly useful in demonstrating the multiple metatarsal and cuneiform fractures that can be associated with a ligamentous Lisfranc injury, and are often used for preoperative planning for fracture treatment and evaluation 1.
From the Research
Definition of Homolateral Lisfranc Injury
- A homolateral Lisfranc injury refers to a type of injury that occurs on the same side of the foot, involving the tarsometatarsal joint 2.
- This type of injury is a subset of Lisfranc injuries, which are relatively rare and often misdiagnosed as a foot sprain [(2,3,4)].
Characteristics of Homolateral Lisfranc Injury
- Homolateral Lisfranc injuries can be classified as type A, according to the Hardcastle and Meyerson classification 2.
- These injuries can be caused by high-energy trauma or minor trauma, and can present with symptoms such as chronic foot pain, swelling, and joint instability [(2,3,4)].
- Radiological workup, including anteroposterior, lateral, and medial oblique views of the foot, is essential for diagnosis [(2,3,4)].
Treatment and Management
- Treatment of homolateral Lisfranc injuries depends on the severity of the injury, with stable injuries potentially being managed conservatively and unstable injuries requiring surgical intervention [(3,4,5)].
- Open reduction and internal fixation (ORIF) with plates and screws is a common surgical approach for treating these injuries [(2,5)].
- Early diagnosis and treatment are crucial to achieve good outcomes and prevent complications such as post-traumatic osteoarthritis and foot deformities [(3,4,5)].