A 25-year-old footballer sustains a twisting injury to his foot during a match. He has midfoot swelling and tenderness over the base of the second metatarsal, with inability to bear weight. X-ray reveals a small avulsion fracture at the medial base of the second metatarsal and widening of the space between the first and second metatarsal bases. This injury is most consistent with:
- A Jones fracture
- B Chopart fracture-dislocation
- C Lisfranc fracture-dislocation ✓
- D Navicular stress fracture
Correct answer: C. Lisfranc fracture-dislocation
Explanation
Lisfranc injury involves disruption of the tarsometatarsal joint complex. The key radiographic finding is widening between the first and second metatarsal bases with an avulsion fracture at the medial base of the second metatarsal (fleck sign). Inability to bear weight and midfoot tenderness are classic. Jones fracture is a diaphyseal fifth metatarsal fracture. Chopart involves the midtarsal joints. Navicular stress fracture presents with vague midfoot pain, not acute instability.
Reference: Rockwood and Green's Fractures in Adults, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.