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26 Jul 2025
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Divergent Lisfranc Injury with 5th Metatarsal Base Fracture

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Clinical Details

Clinical and radiological findings:  A patient presented with a divergent Lisfranc injury, characterized by intercuneiform instability. The injury included an uncommon fracture of the 5th metatarsal base, which is crucial for restoring the relationship between the 4th and 5th tarsometatarsal joints. Radiological evaluation confirmed the presence of a divergent pattern with significant intercuneiform instability.

Preoperative Plan

Planning remarks:  The preoperative plan involved an open reduction to address the 5th metatarsal base fracture and stabilize the Lisfranc joint complex. Tension band plating was chosen for the 5th metatarsal base fracture due to its tension-type nature.

Surgical Discussion

Patient positioning:  Supine position with the affected foot elevated on a radiolucent table to allow for intraoperative imaging and access.

Anatomical surgical approach:  A dorsal approach to the midfoot was utilized, with careful dissection to expose the tarsometatarsal joints and the 5th metatarsal base. The intercuneiform instability was addressed through direct visualization and reduction.

Operative remarks: 

The surgeon emphasized the importance of achieving an anatomic reduction of the 5th metatarsal base fracture to restore the 4th and 5th tarsometatarsal joint relationship. Tension band plating was preferred over percutaneous or screw-assisted reduction techniques, which were deemed inadequate for this fracture pattern.

Postoperative protocol:   Postoperative protocol included immobilization in a non-weight-bearing cast for 6 weeks, followed by progressive weight-bearing as tolerated, with physical therapy initiated at 8 weeks to restore range of motion and strength.

Follow up:   Not specified

Orthopaedic implants used:   Tension band plate for 5th metatarsal base fracture fixation.

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