Case Report-Management of Lisfranc Injury with Communited Medial Cuneiform Fracture Using Percutaneous Screws

Background: Lisfranc ligament bundle spans from the first cuneiform to the second metatarsal, as well as the ligament connects the plantar aspect of the medial cuneiform to the bases of the second and third metatarsals, providing substantial stability to the TMT joint line. Mechanisms of injury are varied and may result from both direct and indirect forces. Road accidents are the cause of more than two-third of these injuries, followed by direct crush injuries and falls from a height. A detailed history (mechanism of injury, onset) and clinical examination are supplemented with standardized radiographic imaging to increase sensitivity and specificity, and confirm the diagnosis. Radiographic imaging demonstrates diastasis of the first and second metatarsal with avulsion usually. Treatment depends on the severity of the condition, however most reliable for this particular case was percutaneous fixation with use of partially threaded screws and washer. Case Presentation: A 30-year-old male presented to kurla babha hospital casualty with right foot pain and swelling, following a fall from bike few hours before. His right foot showed swelling and forefoot showed decreased range of motion. There was tenderness on palpation of forefoot. Radiographic imaging with AP and Oblique views of the foot showed an oblique communited fracture of the medial cuneiform and widening of the space between 1st and 2nd metatarsal bone. He was given a below knee slab with elevation of foot over pillow. Routine blood investigations were sent and he was scheduled for surgery after swelling decreased. Two screws were placed percutaneously to stabilize the joints. Post-operatively, no complications were observed, and the patient was advised to follow up in the OPD. Conclusion: Acute injuries to the Tarsometatarsal or Lisfranc joint are rare accounting for 0.1% to 0.4% of all fractures and dislocations. Despite improvements in diagnosis, missed or overlooked injuries are common. Especially the isolated pure ligamentous TMT instability is misdiagnosed in up to 20%. Insufficient treatment can lead to painful secondary deformity and impaired function. While, nonoperative treatment has been linked to an increased incidence of secondary displacement and inferior functional outcome, primary open reduction and internal fixation has become the preferred method of treatment when there is structural ligamentous instability or fracture?dislocation. However, there is no enough data in the literature regarding surgical treatment, complications and functional outcomes of Lisfranc injuries. More studies are needed to clarify a definitive treatment for patients with ligamentous injuries.