Fractures - Dubai Sports Orthopaedics

Lisfranc Injury

This is a fracture dislocation of the second metatarsal and midfoot bone (medial cuneiform).

It only accounts for 0.2% of all fractures but is very commonly missed. The injury is usually caused by a rotational and axial loading force in the hyperflexed foot. Clinical symptoms are severe pain, swelling of the midfoot and inability to weight-bear. Radiographs are essential for diagnosis but often a CT scan is required. If there is no displacement on weight-bearing Xrays, treatment with a cast and strict non weight-bearing for 8 weeks is sufficient. Any evidence of instability requires surgical fixation.

5^th Metatarsal Base Fracture

Inversion of the hindfoot, adduction of the forefoot or repetitive microtrauma are the main mechanisms of injury.

In zone 1 the peroneus brevis tendon or plantar ligament pulls on the bone and cause an avulsion. Non-healing is uncommon and protected weight-bearing in a stiff soled shoe or boot limited by pain is the main treatment. In zone 2 it involves the joint between the 4^th and 5^th metatarsal. Nonunion is common (15-30%) and treatment requires at least cast immobilization for 6-8 weeks. Alternatively surgery using a long screw can be utilized.  In zone 3 repetitive microtrauma causes stress fractures with  poor bone healing. Similar treatment as for zone 2 injuries can be attempted but often sugery and even bone grafting is indicated if the fracture shows signs of sclerosis and obliteration of the medullary canal.