1. 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

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

3. MRI 6 weeks post injury

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

5. 1-year follow-up

6. 10-year follow-up

7. 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 Sep;117(9):791–797.
Zwipp et al. Unfallchirurg. 2014;117:791–797