Case for small group discussion Severe midfoot sprain Case for small group discussion AOTrauma—Foot & Ankle Module 4a: Midfoot trauma—lisfranc fractures Stefan Rammelt and Hans Zwipp, DE

Case description 15-year-old female olympic gymnast X-ray ordered as “foot in 2 planes” Diagnosed as “midfoot sprain”

MRI 6 weeks post injury

Anatomical Lisfranc ligamentoplasty Using half the extensor hallucis longus tendon (Hans Zwipp)

1-year follow-up

10-year follow-up

Take-home messages Lisfranc ligamentoplasty due to special circumstances (young gymnast) Alternatively consider 1st and/or 2nd TMT fusion for late presenting cases Anatomical reduction is essential Adequate comparative weight-bearing or stress x-rays to detect purely ligamentous instability Reference: Zwipp H, Rammelt S. [Anatomical reconstruction of chronically instable Lisfranc's ligaments]. Unfallchirurg. 2014 Sep;117(9):791–797. Zwipp et al. Unfallchirurg. 2014;117:791–797