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Fractures & Dislocations

Foot & ankle fractures/dislocations: Lisfranc injury recognition, pantalar/subtalar management, and associated soft tissue considerations.

Overview

Foot fractures and dislocations are common traumatic injuries associated with high rates of morbidity and dysfunction [2]. Management requires a thorough understanding of classifications and management strategies to ensure anatomic alignment and functional recovery [2].

Surgical intervention is often indicated for complex or delayed presentations. Open reduction internal fixation (ORIF) is recommended for patients with delayed presentation of combined fourth and fifth carpometacarpal fracture dislocations [4]. For bony and fracture-dislocation Lisfranc injuries, ORIF is preferred when joint surfaces are salvageable, whereas arthrodesis is indicated when long-term preservation is not feasible [8]. Recent evidence supports the use of limited arthrodesis in more complex Lisfranc injuries [27]. Unstable or displaced Lisfranc injuries require surgical fixation to restore alignment and prevent long-term dysfunction [7].

Non-operative or alternative surgical approaches are appropriate for specific stable or isolated injuries. Closed reduction is the treatment of choice for simultaneous triple dislocation of the small finger without associated lesions [6]. Early treatment is recommended for injuries to the carpometacarpal joint of the little finger, as delays of three days or more may have caused the dislocation in cases requiring open reduction [3]. Postoperative functional results for irreducible dorsal dislocation of the toe were satisfactory, with dislocations remaining reduced [5]. Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity, ranging from injuries that require little intervention to those that require advanced reconstructive surgery for optimal outcome [11]. The success of operative treatment for anterior fracture-dislocation of the proximal interphalangeal joint was attributed to essentially anatomical replacement of both fracture fragments [28].

Surgical treatment of knee dislocations provided satisfactory subjective and objective outcomes at two to six years postoperatively [30]. Surgical treatment with humeral head preserving techniques results in a good to very good mid-term outcome after posterior fracture-dislocations of the proximal humerus [31].

Anatomy & Pathophysiology

Foot fractures and dislocations are common traumatic injuries associated with high rates of morbidity and dysfunction [2]. The majority of foot and ankle injuries in soccer result from tackles involving lateral or medial forces that create eversion or inversion rotation of the foot or ankle [47]. Injuries to the foot in athletes are often subtle, yet undiagnosed or untreated cases can lead to substantial loss of function [49].

Osseous & Joint Complex

Metatarsal fractures can alter the functional characteristics of the forefoot platform [18]. The mechanism for combined fracture of the base of the fifth metatarsal and lateral malleolus is forced inversion while the foot is dorsiflexed, at a right angle, or slightly plantar flexed [42]. Axial loading, external rotation, and pronation/supination are common conditions during injurious loading in tarsometatarsal injuries [48]. The joint between the navicular and the medial cuneiform is exceptionally stable, requiring considerable force to dislocate [67].

Ligamentous & Soft Tissue

Urgent talar relocation restores ankle and hindfoot anatomy and reduces pressure on surrounding soft tissues [10]. Anatomical repair with ligament bracing provides normalized gait patterns for knee joint dislocations [63]. Accurate diagnosis of ankle fracture-dislocation with posterior entrapment of the fibula behind the tibia allows for reduction via traction, medial rotation of the foot, and lateral pushing of the fibular shaft [69].

Biomechanics & Management Principles

Effective treatment of distal forefoot injuries depends on the knowledge of the anatomy of the involved structures [40]. Effective treatment of distal forefoot injuries also depends on the understanding of the biomechanical function of the involved structures [40]. Hallux valgus deformity severity is positively associated with the magnitude of anteroposterior postural sway [57]. Recurrent bilateral mid-tarsal subluxations indicate an underlying structural abnormality [59].

The goal of treatment for tarsometatarsal joint complex injury is the restoration of a pain-free, functional foot [58]. Surgical treatment of Lisfranc fracture-dislocations aims to achieve optimal anatomical reduction and stability of the first, second, and third cuneiform-metatarsal joints [60]. Early diagnosis and management of foot and ankle injuries are critical to ensure efficient and safe return to play [70]. Early diagnosis and management of foot and ankle injuries are critical to avoid compromising healing or long-term functional outcomes [70]. Modern diagnostic tools allow for more accurate diagnosis of sports-related foot injuries [56]. Surgical treatment devices allow for an improved ability to reestablish normal anatomy in sports-related foot injuries [56]. Rehabilitation protocols allow for accelerated return to play for many sports-related foot injuries [56].

Classification

Foot fractures and dislocations are common traumatic injuries associated with high rates of morbidity and dysfunction [2]. Understanding classifications of foot fractures and dislocations is required to ensure anatomic alignment and functional recovery [2].

Medial Cuneiform Dislocation: The roentgenographic appearance of an isolated medial cuneiform bone dislocation can be confusing [1]. Obtaining a detailed history of the mechanism of injury is diagnostically important for isolated medial cuneiform bone dislocations due to potentially confusing radiographic appearance [1].

Lisfranc Injuries: Lisfranc injuries encompass a broad spectrum of injuries that are often difficult to diagnose and treat [14]. Undetected and inappropriately managed Lisfranc injuries can cause long-term disability [14]. Radiographic diagnostic criteria for Lisfranc injuries are heterogeneous [54]. A new classification using three-dimensional fracture lines and heat maps accurately identifies different types of fractures in Lisfranc injuries [19]. The three-dimensional fracture line and heat map classification for Lisfranc injuries assists clinicians in understanding injuries and making decisions to avoid diagnostic delays that negatively impact postoperative outcomes [19].

Proximal Interphalangeal Joint: Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity ranging from those requiring little intervention to those requiring advanced reconstructive surgery [11].

Tibial Spine Fractures: A new MRI-based classification system for tibial spine fractures provides specific, quantitative criteria for classifying fractures according to fragment displacement and tissue entrapment [24]. The MRI-based classification system for tibial spine fractures changes clinical treatment recommendations compared to the Myers and McKeever system [24]. The MRI-based classification system for tibial spine fractures is as reliable as the Myers and McKeever system [24].

Navicular and Midfoot Injuries: A new and reliable classification system for fractures of the navicular and associated midfoot injuries is logical, all-inclusive, and mutually exclusive [46]. The navicular fracture classification system gives associated injuries involving the lateral column due consideration [46].

Patellar Dislocations: A new classification for traumatic patellar dislocations was proposed to aid in diagnosis and treatment [45].

Other Considerations: Existing classification systems for complex extremity fractures are inadequate and lack therapeutic recommendations [39]. Understanding the classification and grade of stress fractures is key to optimal care of the athlete regarding return-to-play decisions [43]. Fatigue fractures of the tarsal navicular had not been previously reported in man as of 1970 [26].

Clinical Presentation

Isolated dislocation of the medial cuneiform bone is a rare injury of the tarsus [1]. Foot fractures and dislocations are common traumatic injuries associated with high rates of morbidity and dysfunction [2]. The roentgenographic appearance of an isolated medial cuneiform dislocation can be confusing [1]. Obtaining a detailed history of the mechanism of injury is diagnostically important for isolated medial cuneiform dislocations [1].

Lisfranc injuries encompass a broad spectrum of injuries that are often difficult to diagnose and treat [14]. Undetected and inappropriately managed Lisfranc injuries can cause long-term disability [14]. A high level of suspicion, recognition of clinical signs, and appropriate radiographic studies are needed for the correct diagnosis of Lisfranc joint injuries to avoid late sequelae of posttraumatic arthritis [17]. A new classification using three-dimensional fracture lines and heat maps accurately identifies different types of fractures in Lisfranc injuries [19]. This classification assists clinicians in understanding Lisfranc injuries and making sound decisions to avoid diagnostic delays that can negatively impact postoperative outcomes [19].

Carpometacarpal joint dislocations and fracture dislocations of the index through small digits are uncommon injuries that can be very disabling if not recognized early [16]. Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity, ranging from injuries requiring little intervention to those requiring advanced reconstructive surgery for optimal outcome [11]. Closed reduction is the treatment of choice for simultaneous dislocations of the small finger without associated lesions [6].

Trapezoid fractures may be underdiagnosed, and computed tomography is recommended over plain radiography alone in case of clinical suspicion [20]. Clinical exams may not reveal associated fractures with subtalar dislocations [21]. Complete anterior dislocation of the sacro-iliac joint is a very unusual injury that can occur in skeletally mature individuals following severe trauma [22]. Posterior glenohumular dislocation can occur in association with a posterior acromion fracture [23]. Early diagnosis and reduction of crystal dislocations should be accomplished by closed or, if necessary, open reduction [25]. Patients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes if the injury is urgently diagnosed and properly managed [44].

Investigations

Plain radiography: Obtaining a detailed history of the mechanism of injury is diagnostically important because the roentgenographic appearance of dislocation can be confusing [1]. Appropriate roentgenographic techniques are significant for the diagnosis of ligament injuries associated with ankle injuries [76]. However, clinical exams may not reveal associated fractures with subtalar dislocations, such as navicular and entire posterior talar process fractures [21]. Salter-Harris type-III fracture of the medial femoral condyle may be unrecognized or mistaken for disruption of the medial collateral ligament if routine radiographs are not diagnostic [32]. The classic dimple sign may be absent in chronic irreducible posterolateral knee dislocation [72].

Computed tomography: Computed tomography is recommended over plain radiography alone for trapezoid fractures in case of clinical suspicion, as these fractures may be underdiagnosed [20]. Computed tomographic scanning is valuable for diagnosing fracture of the atlantal arch causing atlanto-axial instability when plain radiographs are inconclusive [71]. CT scans are recommended when there is high clinical suspicion of talus injuries, as they offer greater accuracy for complex and subtle injuries compared to plain radiographs [73].

Magnetic resonance imaging: An MRI-based classification system for tibial spine fractures provides specific, quantitative criteria for classifying fractures according to fragment displacement and tissue entrapment [24]. MRI is recommended for all patients presenting with acute patellar dislocation to evaluate soft tissue damage and guide management [37].

Bone scan: A bone scan is the best way to establish an early diagnosis of stress fractures of the carpal scaphoid, and a negative radiograph should not dissuade from performing one [75]. Serial roentgenographic studies are necessary to demonstrate the evolution of multiple stress fractures in rheumatoid arthritis [13].

Other Considerations: Early treatment is recommended for carpometacarpal joint injuries, as delays of three days or more may have caused the dislocation in cases requiring open reduction [3]. Carpometacarpal joint dislocations and fracture dislocations are uncommon injuries that can be very disabling if not recognized early [16]. Unstable or displaced Lisfranc injuries require surgical fixation to restore alignment and prevent long-term dysfunction [7]. A high level of suspicion, recognition of clinical signs, and appropriate radiographic studies are needed for correct diagnosis of Lisfranc joint injury to avoid late sequelae of posttraumatic arthritis [17]. Stress fractures of the acetabulum are difficult to diagnose and can lead to devastating injuries if not appropriately diagnosed and treated [15]. Early diagnosis and reduction of crystal dislocations should be accomplished by closed or, if necessary, open reduction [25].

Treatment

Non-Operative

Nonoperative management is appropriate for stable Lisfranc injuries, which generally yield good outcomes [53]. Bilateral fractures of the transverse process of the atlas are stable and may be treated nonoperatively [61]. For hyperextensibility of the proximal interphalangeal (PIP) joint following trauma, immediate adequate reduction followed by prolonged immobilization in moderate flexion constitutes the best treatment [52]. Closed reduction is the treatment of choice for simultaneous dislocations of the small finger without associated lesions [6]. Prior experience with closed methods for acute rupture of the peroneal retinaculum was disappointing, resulting in persistent pain and recurrent dislocations [12]. Nonoperative management or delayed surgery for acute distal semimembranosus tendon avulsions may result in poor outcomes [68].

Operative

Indications: Open reduction and internal fixation (ORIF) is recommended for patients with delayed presentation of carpometacarpal (CMC) fracture dislocations [4]. Delays of three days or more in treating injuries to the CMC joint of the little finger may have caused the dislocation in cases requiring open reduction [3]. Unstable or displaced Lisfranc injuries require surgical fixation to restore alignment and prevent long-term dysfunction [7]. Displaced or comminuted Lisfranc injuries require surgical intervention, with ORIF being the most common approach [53]. Surgical treatment is indicated for acute rupture of the peroneal retinaculum due to the failure of closed methods [12]. Late surgical treatment for hyperextensibility of the PIP joint involves suture of the avulsed capsule with subsequent immobilization and rehabilitation for cases with persistent pain, swelling, or disabling instability [52].

Surgical Approach / Technique: For bony and fracture-dislocation Lisfranc injuries, ORIF is preferred when joint surfaces are salvageable, while arthrodesis is indicated when long-term preservation is not feasible [8]. Limited arthrodesis is supported for more complex Lisfranc injuries [27]. The success of operative treatment for anterior fracture-dislocation of the PIP joint is attributed to essentially anatomical replacement of both fracture fragments [28]. Surgical treatment with humeral head preserving techniques results in a good to very good mid-term outcome after posterior fracture-dislocations of the humerus [31].

Implant Selection: Prevention of non-union depends to a great extent on the application of well-established sound principles of fracture management [50].

Alignment / Balancing Strategy: Not applicable.

Pain Management: Not applicable.

Adjuncts: Not applicable.

Setting of Care: Surgical management of spiral oblique fractures of the fifth metatarsal leads to faster return to play in athletes [35]. Operative and nonoperative management of dancer's fracture (spiral oblique fractures of the fifth metatarsal) demonstrate comparable radiographic outcomes, low failure rates, and low complication rates at short-term follow-up [35].

Revision: Not applicable.

Other Considerations: MRI is recommended for all patients presenting with acute patellar dislocation to evaluate soft tissue damage and guide management [37]. Surgical treatment of knee dislocations provided satisfactory subjective and objective outcomes at two to six years postoperatively [30]. However, surgical treatment of knee dislocations improves outcomes compared to nonoperative management, yet many patients remain unable to return to physical occupations or sporting activities due to the severity of injuries and associated trauma [55]. Postoperative outcomes for irreducible dorsal dislocation of the toe include maintained reduction and satisfactory functional results [5]. Metatarsal fractures are common injuries in athletes that can alter the functional characteristics of the forefoot platform [18].

Complications

General Morbidity: Foot fractures and dislocations are associated with high rates of morbidity and dysfunction [2].

Instability: Delayed presentation of carpometacarpal (CMC) fracture dislocations may cause the dislocation [3]. Unstable or displaced Lisfranc injuries require surgical fixation to prevent long-term dysfunction [7]. Arthrodesis is indicated for Lisfranc injuries when long-term preservation of the joint is not feasible [8]. Closed methods of treatment for acute rupture of the peroneal retinaculum result in persistent pain and recurrent dislocations [12]. Complete anterior dislocation of the sacro-iliac joint is a very unusual injury [22]. Posterior glenohumeral dislocation can occur in association with a posterior acromion fracture [23].

Growth and Development: Long-term follow-up is required for physeal fractures to monitor for growth arrest and deformities [29].

Pediatric Hip Dislocation: Delay in reduction of hip dislocations in young children under six years is associated with poorer outcomes [38]. Early unrestricted weight-bearing after hip dislocation in young children under six years is associated with poorer outcomes [38].

Recovery

Foot fractures and dislocations are associated with high rates of morbidity and dysfunction, requiring management to ensure anatomic alignment and functional recovery [2]. Unstable or displaced Lisfranc injuries require surgical fixation to restore alignment and prevent long-term dysfunction [7]. For bony and fracture-dislocation Lisfranc injuries, open reduction and internal fixation (ORIF) is preferred when joint surfaces are salvageable [8]. Arthrodesis is indicated for bony and fracture-dislocation Lisfranc injuries when long-term preservation of the joint is not feasible [8]. Column involvement, rather than sagittal displacement, is the most significant factor in determining the severity of Lisfranc injury and long-term functional outcomes [64]. Persistent pain and functional limitations are frequent after pantalar dislocation [65].

Long-term follow-up is required for physeal fractures to monitor for growth arrest and deformities [29]. Young children under six years with simple hip dislocations almost always have a good result [38]. Delay in reduction of hip dislocations in young children is associated with poorer outcomes [38]. Early unrestricted weight-bearing after hip dislocation in young children is associated with poorer outcomes [38]. Good short- and mid-term outcomes can be expected after arthroscopic reduction of locked patellar dislocation [33]. Long-term outcomes after extension block pinning for fracture-dislocations of the proximal interphalangeal joint are satisfactory and similar to mid-term follow-up results [34]. Anatomical repair of lateral ligaments in posteromedial ankle dislocation without fracture achieves good long-term functional and roentgenographic results [36].

Key Evidence

  • [L4] The diagnostic importance of obtaining a detailed history of the mechanism of injury is stressed, because the roentgenographic appearance of the dislocation can be confusing. (10.2106/00004623-197052080-00012)
  • [L4] Early treatment is recommended as all cases requiring open reduction had a delay of three days or more, which may have caused the dislocation. (10.2106/00004623-197456070-00014)
  • [L4] In patients with delayed presentation of CMC fracture dislocations, we recommend ORIF. (10.1016/j.jhsa.2015.07.017)
  • [L4] Postoperatively, the dislocations remained reduced and the functional results were satisfactory. (10.2106/00004623-198870050-00019)
  • [L4] Closed reduction is the treatment of choice for simultaneous dislocations without associated lesions. (10.1016/j.jhsa.2012.10.043)
  • [L5] In contrast, unstable or displaced injuries continue to require surgical fixation to restore alignment and prevent long‐term dysfunction. (10.1002/ksa.70244)
  • [L5] For bony and fracture-dislocation injuries, ORIF is preferred when joint surfaces are salvageable, while arthrodesis is indicated when long-term preservation is not feasible. (10.1002/ksa.70261)
  • [L4] Urgent talar relocation restores ankle and hindfoot anatomy and reduces pressure on surrounding soft tissues to optimize outcome. (10.5435/jaaos-d-20-00836)
  • [L5] Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity, ranging from injuries that require little intervention to those that require advanced reconstructive surgery for optimal outcome. (10.5435/jaaos-21-02-88)
  • [L4] Prior experience with closed methods of treatment was disappointing, with persistent pain and recurrent dislocations. (10.2106/00004623-197658050-00016)
  • [L5] A heightened awareness and serial roentgenographic studies are necessary to demonstrate the evolution of these fractures. (10.2106/00004623-196749070-00017)
  • [L4] Lisfranc injuries encompass a broad spectrum of injuries that are often difficult to diagnose and treat; if not detected and appropriately managed, they can cause long-term disability. (10.1016/j.injury.2014.11.026)
  • [L4] Stress fractures of the acetabulum are difficult to diagnose and can lead to devastating injuries if not appropriately diagnosed and treated. (10.1177/0363546515593953)
  • [L5] Carpometacarpal joint dislocations and fracture dislocations are uncommon injuries that can be very disabling if not recognized early. (10.5435/jaaos-d-25-00583)
  • [L5] A high level of suspicion, recognition of clinical signs, and appropriate radiographic studies are needed for correct diagnosis to avoid late sequelae of posttraumatic arthritis. (10.5435/00124635-201012000-00002)
  • [L5] Metatarsal fractures are common injuries in athletes that can alter the functional characteristics of the forefoot platform. (10.1016/j.csm.2005.08.014)
  • [L4] The new classification accurately identifies the different types of fractures in Lisfranc injuries, enabling clinicians to more fully and accurately understand their patients' injuries and assisting them in efficiently making sound decisions to avoid diagnostic delays that can negatively impact postoperative outcomes. (10.1186/s13018-025-05663-w)
  • [L4] These fractures may be underdiagnosed, and computed tomography is recommended over plain radiography alone in case of clinical suspicion. (10.1016/j.jhsa.2012.02.046)
  • [Case_report] The purpose of this case is to alert the orthopaedic surgeon of the possibility of associated fractures with subtalar dislocations, as clinical exams may not reveal them. (10.1016/j.injury.2014.12.002)
  • [Case_report] Complete anterior dislocation of the sacro-iliac joint is a very unusual injury that can occur in skeletally mature individuals following severe trauma. (10.2106/00004623-197658010-00028)
  • [L4] Two cases document an unusual injury pattern in which a posterior glenohumeral dislocation occurred in association with a (posterior) acromion fracture. (10.1016/j.xrrt.2025.09.006)
  • [L2] The MRI-based system is as reliable as the MM system and provides specific, quantitative criteria for classifying fractures according to fragment displacement and tissue entrapment. (10.1007/s00167-018-5039-7)
  • [L4] This type of fracture has not been previously reported in man. (10.2106/00004623-197052020-00023)
  • [L4] Recent evidence supports the use of limited arthrodesis in more complex injuries. (10.1007/s00167-013-2491-2)
  • [Case_report] The success of the operative treatment was attributed to essentially anatomical replacement of both fracture fragments. (10.2106/00004623-197961050-00025)
  • [L3] Surgical treatment of the knee dislocations in our series provided satisfactory subjective and objective outcomes at two to six years postoperatively. (10.2106/jbjs.d.02711)
  • [Abstract] Surgical treatment with humeral head preserving techniques results in a good to very good mid-term outcome after posterior fracture-dislocations of the humerus. (10.1016/j.jse.2022.01.075)
  • [L4] The fracture may be unrecognized or mistaken for disruption of the medial collateral ligament if routine radiographs are not diagnostic. (10.2106/00004623-198163040-00008)
  • [L5] Despite the major impact of the trauma mechanism, it shows that good outcome in the short- and mid-term can be expected. (10.1007/s00167-018-4959-6)
  • [L4] The long-term outcomes were satisfactory and similar to the mid-term follow-up results of the same patient cohort reported 11 years earlier. (10.1177/17531934221102251)
  • [L4] This systematic review demonstrated comparable radiographic outcomes together with low failure rate and low complication rate following both operative and nonoperative management of dancer's fracture at short‐term follow‐up. (10.1002/ksa.12098)
  • [L4] Three patients with closed dislocation and five patients with open injuries treated by anatomical repair of the lateral ligaments achieved good long-term functional and roentgenographic results. (10.2106/00004623-198769050-00011)
  • [L4] MRI is recommended for all patients presenting with acute patellar dislocation to evaluate soft tissue damage and guide management. (10.1186/1749-799x-7-21)
  • [L4] Young children under six years with simple dislocations almost always have a good result, while delay in reduction and early unrestricted weight-bearing are associated with poorer outcomes. (10.2106/00004623-196850010-00005)
  • [L5] Existing classification systems for complex extremity fractures are inadequate and lack therapeutic recommendations. (10.1016/j.injury.2009.10.039)
  • [L5] Effective treatment of injuries of the distal forefoot essentially depends on the knowledge of the anatomy and the understanding of the biomechanical function of the involved structures. (10.1016/j.injury.2004.07.015)
  • [L4] The mechanism of production is forced inversion while the foot is dorsiflexed or at a right angle or slightly plantar flexed. (10.2106/00004623-196143040-00006)
  • [Paper] Understanding the classification and grade of stress fractures and their implications on return-to-play decisions is key to optimal care of the athlete. (10.1016/j.csm.2005.08.012)
  • [Case_report] Patients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes, if it is urgently diagnosed and properly managed. (10.1186/s12891-022-05506-3)
  • [Case_report] The authors propose a new classification for traumatic patellar dislocations to aid in diagnosis and treatment. (10.1007/s00167-005-0670-5)
  • [L4] We propose a logical, all-inclusive, and mutually exclusive classification system for fractures of the navicular that gives associated injuries involving the lateral column due consideration. (10.1302/0301-620x.100b2.bjj-2017-0879.r1)
  • [L2] The majority of injuries were caused by tackles involving lateral or medial forces that created a corresponding eversion or inversion rotation of the foot or ankle. (10.1177/03635465030310041201)
  • [L4] Axial loading of the foot, external rotation, and pronation/supination are the most common conditions during injurious loading. (10.1177/2325967114525347)
  • [L4] Injuries to the foot in athletes are often subtle and can lead to a substantial loss of function if not diagnosed and treated appropriately. (10.1302/0301-620x.98b10.37896)
  • [L5] Non-union often results from a combination of adverse situations, and its prevention depends to a great extent on the application of well-established sound principles of fracture management. (10.2106/00004623-196547010-00015)
  • [L4] The best treatment consists of immediate adequate reduction followed by prolonged immobilization in moderate flexion; late treatment involves surgical suture of the avulsed capsule with subsequent immobilization and rehabilitation for cases with persistent pain, swelling, or disabling instability. (10.2106/00004623-195436060-00003)
  • [L4] Stable injuries generally have good outcomes with nonoperative management, while displaced or comminuted injuries require surgical intervention, with open reduction and internal fixation being the most common approach. (10.1302/0301-620x.106b12.bjj-2024-0581.r1)
  • [L4] The radiographic diagnostic criteria of Lisfranc injuries were heterogeneous. (10.1186/s12891-023-07043-z)
  • [L5] Surgical treatment of knee dislocations improves outcomes compared to nonoperative management, yet many patients remain unable to return to physical occupations or sporting activities due to the severity of injuries and associated trauma. (10.1016/j.arthro.2018.02.010)
  • [L5] Modern diagnostic tools, surgical treatment devices, and rehabilitation protocols have allowed for more accurate and rapid diagnosis, an improved ability to reestablish normal anatomy, and accelerated return to play for many sports-related foot injuries. (10.5435/jaaos-d-23-00881)
  • [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
  • [L5] The goal of treatment is the restoration of a pain-free, functional foot. (10.5435/00124635-200307000-00005)
  • [Case_report] The fact that both feet were similarly affected indicates that there was some underlying structural abnormality. (10.2106/00004623-197961040-00027)
  • [L5] Surgical treatment aims to achieve optimal anatomical reduction and stability of the first, second, and third cuneiform-metatarsal joints. (10.1302/2058-5241.4.180076)
  • [L4] The fracture is stable and may be treated accordingly. (10.2106/00004623-198264060-00023)
  • [L4] Anatomical repair with ligament bracing is a suitable surgical procedure for knee dislocation, providing acceptable subjective and objective functional outcomes with normalized gait patterns. (10.1007/s00167-021-06501-2)
  • [L3] Column involvement and not sagittal displacement is the most significant factor in considering the severity of Lisfranc injury and long term functional outcomes. (10.1016/j.injury.2017.03.046)
  • [L4] Persistent pain and functional limitations are frequent after pantalar dislocation, as reflected in extremity-specific and generalized functional outcome scores. (10.2106/jbjs.16.00986)
  • [Case_report] The joint between the navicular and the medial cuneiform is exceptionally stable, requiring considerable force to dislocate. (10.2106/00004623-198365020-00020)
  • [L4] Nonoperative management or delayed surgery may result in poor outcomes. (10.1177/2325967117731102)
  • [L4] If the injury is accurately diagnosed, traction and medial rotation applied to the foot while the fibular shaft is pushed laterally may achieve a stable, satisfactory reduction. (10.2106/00004623-197860030-00007)
  • [L5] Early diagnosis and management of foot and ankle injuries are critical to ensure efficient and safe return to play without compromising healing or long-term functional outcomes. (10.5435/00124635-201009000-00006)
  • [L4] Computed tomographic scanning is valuable for diagnosing this pathology when plain radiographs are inconclusive. (10.2106/00004623-198668080-00024)
  • [L4] The authors bring attention to the clinical, radiographic, and MRI findings associated with chronic irreducible posterolateral knee dislocation, noting that the classic dimple sign may be absent in chronic cases. (10.1016/j.arthro.2005.12.046)
  • [L2] CT scans are recommended when there is high clinical suspicion, as they offer greater accuracy for complex and subtle injuries. (10.1186/s12891-025-09136-3)
  • [L4] A negative radiograph should not dissuade one from making a bone scan, which is the best way to establish an early diagnosis and to permit appropriate treatment. (10.2106/00004623-198971060-00022)
  • [L5] The report emphasizes the significance of ligament injuries and the appropriate roentgenographic techniques for their diagnosis. (10.2106/00004623-195638010-00006)

See Also

References

[1] Isolated Dislocation of the Medial Cuneiform Bone—A Rare Injury of the Tarsus. The Journal of Bone & Joint Surgery. 1970. DOI: 10.2106/00004623-197052080-00012

[2] Chapter 46 Foot Fractures and Dislocations. 2021.

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[4] The Effect of Timing on the Treatment and Outcome of Combined Fourth and Fifth Carpometacarpal Fracture Dislocations. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.07.017

[5] Irreducible dorsal dislocation of the toe. Report of three cases.. The Journal of Bone & Joint Surgery. 1988. DOI: 10.2106/00004623-198870050-00019

[6] Simultaneou Triple Dislocation of the Small Finger. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.10.043

[7] Diagnostic evaluation and nonoperative management of Lisfranc injuries in athletes. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.70244

[8] Operative treatment of Lisfranc injuries in elite athletes: 2024 international foot and ankle sports consensus and systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70261

[10] Closed Pantalar Dislocations: Characteristics, Treatment Approaches, and Outcomes. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-00836

[11] Fracture-dislocations of the Proximal Interphalangeal Joint. Journal of the American Academy of Orthopaedic Surgeons. 2013. DOI: 10.5435/jaaos-21-02-88

[12] Acute rupture of the peroneal retinaculum. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658050-00016

[13] Multiple Stress Fractures in Rheumatoid Arthritis. The Journal of Bone & Joint Surgery. 1967. DOI: 10.2106/00004623-196749070-00017

[14] Lisfranc injuries. Injury. 2015. DOI: 10.1016/j.injury.2014.11.026

[15] Catastrophic Failure of an Acetabular Stress Fracture in a Healthy Male Power Lifter. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515593953

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