Images in Emergency Medicine : Lisfranc Fracture-Dislocation

patient presentation A 22-year-old intoxicated male presented to the emergency department after jumping from a second-story window, landing on his right foot. He was able to ambulate with a great deal of pain across the dorsum of his foot. Physical examination revealed significant tenderness to palpation over the second metatarsal with minimal edema. Final diagnosis/relevant teaching points Radiographs of the foot reveal a fracture-dislocation of the tarsometatarsal or Lisfranc joint. A diastasis between the proximal 1 st and 2 nd metatarsals is seen and indicates an unstable injury (Figures 1 & 2). A bone fragment is present in this area due to an avulsion of the Lisfranc ligament. In addition, the lateral edge of the medial cuneiform does not align with the lateral aspect of the first metatarsal. This malalignment can be the only indication of injuries to the Lisfranc joint in more subtle presentations, which can easily be missed.