A 26-year-old man lands on a plantarflexed foot from a height and has persistent midfoot pain. Weight-bearing radiographs show diastasis of more than 2 mm between the bases of the first and second metatarsals with a small bony fragment in the interval. The most appropriate management is:

• A Elevated shoe insert and gradual return to activity
• B Open reduction and internal fixation of the tarsometatarsal joint ✓
• C Short leg cast for six weeks without reduction
• D Primary arthrodesis of the whole midfoot

Explanation

Diastasis greater than 2 mm at the first-second metatarsal base with the fleck sign (avulsion of the Lisfranc ligament attachment) confirms a displaced Lisfranc injury. These injuries require anatomical open reduction and internal fixation, usually with screws across the second tarsometatarsal joint, because malreduction leads to painful post-traumatic arthritis. Conservative care is reserved for truly nondisplaced sprains, and primary arthrodesis is considered mainly for severe comminution.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.