Lisfranc Injuries Classification: Overview of Hardcastle, Myerson, and Other Systems
### High-Impact Lisfranc Injuries: Understanding Treatment and Classification
Lisfranc injuries, named after French surgeon Jacques Lisfranc de St. Martin, are complex foot injuries that can result from high-impact trauma. While the Myerson classification system, commonly used to categorise these injuries, does not explicitly address high-impact injuries, it provides a framework for understanding their severity based on displacement and instability.
The Myerson classification system divides Lisfranc injuries into three main types: Type A, Type B, and Type C. Type A injuries involve total dislocation between the tarsal and metatarsal bones in the same direction. Type B injuries show partial dislocation, with subtypes B1 referring to medial dislocation of the first toe, and B2 referring to lateral dislocation of the second to fifth toe bones. Type C injuries involve the partial dislocation of some of the tarsal and metatarsal bones moving in opposite directions, with Type C2 being complete dislocation of all bones.
Stage 1 involves a sprain of a Lisfranc ligament with no findings on scans, no loss of structure of the foot or arch of the foot, and no changes to the bone. Stage 2, however, involves clear injury to the Lisfranc ligaments, of one to five millimetre change, with no loss of structure to the foot or the arch of the foot. Stage 3 involves more severe damage, with a clear injury to the Lisfranc ligament greater than 5 millimetres in length, additional damage to the plantar ligaments, and a possible fracture in the bones of the feet.
In the case of high-impact Lisfranc injuries, particularly those involving significant trauma, the treatment often involves surgical intervention. Open Reduction and Internal Fixation (ORIF) is the preferred method, involving surgically aligning the bones and stabilizing them with screws or plates to ensure proper healing and alignment. Kirschner wires, thin wires used to stabilize smaller bones or fractures temporarily, might also be used in conjunction with other fixation methods.
For less severe injuries, non-surgical management might include immobilization and physical therapy. However, this approach is less common for high-impact injuries due to the potential for significant instability.
It is important to note that missed injuries are common, especially in low-energy trauma, but consistent imaging techniques like CT scans can reduce this number. Complications can arise from both the injury itself and the surgical treatment, including infection and nerve damage.
The specific treatment approach is tailored to the severity of the injury and the individual's overall health. In Stage 3, the aim is to reduce the displacement between the bones and the ligament disruption non-operatively, or if required, internal fixing of the ligaments.
The Nunley and Vertullo classification system is used for less traumatic Lisfranc injuries, including low-impact sprains that typically affect athletes. This system provides a different approach to categorising and treating these injuries.
In conclusion, understanding the classification and treatment of Lisfranc injuries is crucial for proper management and recovery. High-impact injuries, while not explicitly addressed by the Myerson classification system, are typically treated with surgical intervention to ensure proper alignment and healing.
- In the context of health and wellness, understanding the classification and treatment of high-impact Lisfranc injuries is significant for proper management and recovery, often requiring surgical intervention such as Open Reduction and Internal Fixation (ORIF).
- Chronic diseases like chronic foot issues, including high-impact Lisfranc injuries, can be managed with science-based medical-conditions knowledge and appropriate treatment, which can help maintain overall health and wellness.
