Lisfranc Injury Fixation

Indications

Lisfranc Fracture / Dislocations, radiograph and ct reconstruction of a lisfranc fracture dislocation
Radiograph and CT reconstruction of a Lisfranc fracture dislocation. Image by Hellerhoff, Wikimedia Commons, CC BY-SA 4.0.
  • Unstable tarsometatarsal injuries
  • Diastasis between the first and second metatarsal bases on weight bearing or stress views
  • Primary partial arthrodesis for purely ligamentous injuries (Ly and Coetzee, JBJS 2006)
  • Suspect the injury with plantar arch bruising and midfoot pain after a twisting or crush injury
  • Fleck sign at the base of the second metatarsal indicates a ligament avulsion
  • CT for fracture pattern and MRI for subtle ligament injury

Position

  • Supine, thigh tourniquet

Operative Steps

  1. Two dorsal longitudinal incisions with wide skin bridges
  2. Protect the deep peroneal nerve and dorsalis pedis artery
  3. Reduce the second metatarsal base into its mortise
  4. Lisfranc screw from the medial cuneiform to the second metatarsal base
  5. Medial column with transarticular screws or dorsal bridge plates
  6. Lateral column with K wires to keep it mobile
  7. Delay surgery until swelling settles, often 10 to 14 days
  8. Bridge plating avoids articular damage from transarticular screws
  9. Anatomical reduction is the main determinant of outcome

Postoperative Care

  • Non weight bearing for 6 to 8 weeks
  • Remove lateral wires at about 6 weeks
  • Progressive weight bearing in a boot from about 8 weeks
  • Medial column hardware is often removed at about 4 to 6 months unless fused

Complications

  • Post-traumatic arthritis
  • Foot compartment syndrome
  • Neurovascular injury
  • Loss of reduction
  • Missed injury, about 20% at first presentation
  • Hardware failure and painful hardware

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.