Lisfranc fleck sign: characteristics and clinical outcomes following fixation using a percutaneous position Lisfranc screw



Avulsion of the Lisfranc ligament, fleck sign, results in unstable Lisfranc injuries. This cross-sectional study was conducted to investigate the characteristics of Lisfranc injuries with fleck sign and the clinical and radiological outcomes following closed reduction and percutaneous screw fixation.


All consecutive operatively managed Lisfranc injuries with fleck sign were reviewed from 2016 to 2018. The injury pattern and characteristics of Lisfranc fleck sign were reviewed based on the preoperative CT scan. Postoperative complications besides radiological and clinical outcomes were assessed using visual analog scale (VAS) pain, American orthopedic foot and ankle society (AOFAS) midfoot scale, and foot function index (FFI).


Thirty patients (20 males; mean age, 36.9 ± 17.0; range, 12–69 years) with mean follow-up 16.9 ± 7.4 (range, 6–31) months were enrolled. Among 12 cases with avulsed Lisfranc ligament from the second metatarsal base, only two cases had isolated second metatarsal base fracture in plantar medial part while others had concomitant avulsion fracture of plantar aspect of the adjacent third and/or fourth metatarsal base. Mean of postoperative VAS pain, AOFAS midfoot scale, and FFI were 1.03 ± 0.29, 91.43 ± 1.43, 24.43 ± 6.66, respectively. We had seven (23.3%) removal of screws, two (6.6%) broken screws, four (13.3%) pulled-out screws, and six (20%) lost reductions in the final follow-up with good clinical functions.


Closed reduction and percutaneous fixation of the Lisfranc injuries with fleck sign by a single position screw could be a good surgical option with reliable and predictable outcomes without needing to remove the hardware, routinely.

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This article has been obtained from a thesis (registered no. 1396-01-01-16170) submitted to the Shiraz University of Medical Sciences in partial fulfillment of the requirement for the degree of specialty in orthopedic surgery. The project is sponsored by Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences.


The project was financed by Vice Chancellor for Research of the Shiraz University of Medical Science (Grant no. 1396-01-01-16170).

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Correspondence to Amir Reza Vosoughi.

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Pourmorteza, M., Vosoughi, A.R. Lisfranc fleck sign: characteristics and clinical outcomes following fixation using a percutaneous position Lisfranc screw. Eur J Trauma Emerg Surg (2020).

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  • Lisfranc
  • Tarsometatarsal joint
  • Fleck sign
  • Midfoot
  • Fracture
  • Position screw