Authors of section


Khairul Faizi Mohammad, Brad Yoo

Executive Editors

Richard Buckley, Markku T Nousiainen

Open all credits

Dynamic fixation of ruptured Lisfranc ligament

1. Introduction

The principle of this procedure is to stabilize the anatomic relation between the base of the second metatarsal and the medial cuneiform using dynamic fixation. This fixation involves using suture tape, which is anchored against the bone using metal buttons medially and laterally.

A wide range of fixation devices exist for this procedure, and the technique for tightening the suture tape will vary.

2. Approach

This procedure is performed using both:

3. Reduction

To facilitate the application of the reduction forceps, a K-wire may be used to create a recess laterally at the base of the second metatarsal and medially on the medial cuneiform.

Use pointed reduction forceps to reduce the second metatarsal base to the medial cuneiform. Be mindful to place the reduction forceps away from the placement of the planned position screw.

The reduction forceps can be used percutaneously and should be applied to provide compression in the vector of the Lisfranc ligament.

Verify the reduction visually and radiographically.

Reduction with forceps of Lisfranc injury in the foot

4. Fixation


Insert a guidewire from the lateral aspect of the second metatarsal base. Under fluoroscopic guidance, direct it towards the medial cuneiform.

Guidewire insertion to fix Lisfranc injury in the foot

Drill over the guidewire using an appropriately sized cannulated drill bit.

Drilling for dynamic fixation of a Lisfranc injury in the foot

Insertion of the dynamic fixation device

Insert the dynamic fixation device and distal button from the cuneiform to the second metatarsal.

Insertion of a dynamic fixation device to treat a Lisfranc injury in the foot

Tighten the dynamic fixation device to anchor the buttons both medially and laterally. Ensure that the buttons are securely anchored directly on the bone.

Dynamic fixation device to treat a Lisfranc injury in the foot

Verification of fixation

Verify reduction of the second metatarsal to the medial cuneiform and the button location under image intensification.

Go to diagnosis