PART I

PRELIMINARY

Fracture is the loss of continuity of bone tissue, cartilage or bone

epiphyseal cartilage and both total and partial. Fractures can occur from a single
traumatic event, repetitive stress, or weakness in the bones abnormal (pathological
fracture). Most fractures are caused by the force of sudden and excessive, which
may include beatings, destruction, bending, twisting, or withdrawal. Fractures can
be caused by direct or indirect trauma. Direct injury meaningful impact on the
bone and result in fractures in the area. Indirect trauma when the fulcrum of a
collision with a fracture berjauhan.1,3
Jacques Lisfranc was a surgeon of Napoleon's most famous for its
development of the midfoot amputation in tarsometatarsal level as a way of
treating foot disorders and frostbite during the Napoleonic wars. His name also
has since become synonymous with various patterns of injuries involving
tarsometatarsal joints (TMTJ) on kaki.Dalam modern medicine, Lisfranc injury
has become a representation of a fracture / dislocation of one tarsometatarsal
complex articular structures - metatarsal, TMTJ, cuneiform, cuboid and
navicular4,5 ,
Lisfranc fracture dislocation incidents have been reported in 1 per 55 000 /
year. The man is between two times to four times more likely to sustain this injury
than women; most commonly in the third decade. One of the largest studies
reported about 76 injured Lisfranc by Myerson et al found that 58% associated
with polytrauma, motor vehicle accidents accounted for nearly two-thirds of all
injuries. Therefore, the Lisfranc fracture dislocation can be misdiagnosed up to
20% of cases with malalignment due to long-term and severe difficulty
fungsional.5
Lisfranc joint complex consists of the joint surface intertarsal,
intermetatarsal, and tarsometatarsal. The complex is formed column medial,
central and lateral, which together form an arch configuration through the
midfoot. Each column is independent of the others, with a unique synovial

1
membrane. Medial column is formed by the first metatarsal and medial
cuneiform, the second column is formed by the second and third metatarsals and
the intermediate and lateral cuneiform, and the third column consists of a cube
and its relation to the fourth and fifth metatarsal. Each column has a sagittal plane
movement amount of each as follows: 3.5 mm, 0.6 mm, and 13 mm, .11
The second metatarsal base hidden between cuneiforms medial and lateral,
and the placement is considered to provide a lot of stability to the joint, by
providing a restriction in plantarflexion and dorsiflexion. In addition, the wedge
shape of the second metatarsal base in conjunction with other forms of metatarsal
is another component that adds stability to the joint, because it provides stability
in the frontal plane, allowing it to function ditingkatkan.11
Lisfranc ligaments around the joint structure has been found to have a
moderate variability in cadaveric studies, and may or may not be present as a
thickening of the lining surrounding capsular. Each structure consists of
longitudinal and oblique fibers, and together, the ligaments are grouped into the
dorsal, interosseous and plantar. There are 6 to 8 dorsal ligaments in the group,
and this flat structure joining the tarsal and metatarsal bones. Interosseous
ligament group consisted of 3 groups, including intercuneiform interosseous
ligament, which has been found to provide significant stability in sendi.11
The structure of the other main stabilizer in this group and the whole
complex joints regarded as a Y-shaped ligament that connects the base of the
second metatarsal medial to the lateral aspect of the medial cuneiform, and is
referred to as the Lisfranc ligament. No ligament intermetatarsal between the first
and second metatarsal base, and this may contribute to the propensity for injury
type of dislocation in the region ini.11
from the surrounding soft tissue structures. In general, the components of
joints bigger than the plantarly. Fibrous membrane lined with synovium complex
split into 3 divisions, and is referred to as the capsule artikular.11
Lisfranc injury is a fracture dislocation of the midfoot. The mechanism of
injury can vary from simple to the distension of high-energy trauma. Early
diagnosis is very important right. There is no absolute consensus on the definitive

2
treatment, however, closed reduction and K-wire fixation should be avoided.
Open reduction and internal screw fixation or primary arthrodesis of the medial
column and center, especially on pure ligament injury, direkomendasikan.2

CHAPTER II
CASE
I. IDENTITY
Name : Lila Tn.Satu Date of entry : 11/07/2018
Age : 59 Years Room : Lotus

3
 JK : Man Hospital : Hospital Undata

II. History •
Main complaint : Nyeri and wound on the right foot

Trauma history : Traffic accident

mechanisms Trauma :
Patients experienced a traffic accident on July 10, 2018 at 13:00 pm,
the patient riding a motorcycle out of the driveway and suddenly from the way
patients struck by a passing motorcycle. Patient fell and slammed into the
street. Patient falls towards the left and collided head aspal.Beberapa time after
the fall of patients calling for help then unconscious.

Guided anamnesis :
Patient referrals from hospitals Torabelowith complaints of pain and
lacerations uk ± 8cm x 6cm x 7cm on the right upper leg and fingers is difficult
to be moved perceived since ± 12 hours before entering the hospital, patients in
a motorcycle accident at around 13:00 pm or approximately ± 12 hours then.
Patients experience riding a motorcycle accident while going out of the yard,
on the street suddenly another motorcyclist hit from the right side of the
patient. Patients say shortly after the accident, the patient had called for help,
then lost consciousness and was taken to hospital Torabelo. No head injury, a
history of vomiting 1x undata upon arrival at the hospital. Patient complaints of
dizziness and headaches, heartburn does not exist, BAK smooth, regular
toileting. Patient denies taking drugs.

Peyakit history History: Patients claimed to have never experienced a disease

that made him hospitalized earlier. No history of hypertension, diabetes mellitus,
asthma.

4
 Family history of disease: No family to suffer the same events. No history of
hypertension, diabetes mellitus, asthma on the family members.

III. generalized status

MY : Pain was
GCS : E4 V5 M6
Weight : 67kg
TB : 172 cm
IMT : 22.7 (Normal)
Head : normocephal
Eye : Pale eyelid conjungtiva (- / -), sclera jaundice (- / -), pupil
isokor (- / -) raccon eye (- / -)
Nose : Breath lobe (-), secretions (-), septal deviation (-), rhinorrea (-)
Ear : Discharge (- / -), ottorhea (-),
Mouth : Lip cyanosis (-), parrese
Throat : T1-T1 values, pharyngeal hyperemia (-).
Neck : Symmetrical, the middle trachea, lymph node enlargement
(-)
thorax
Pulmo
inspection : Static and dynamic symmetric, Retraction between the ribs
(- / -), injury (-), edema (-), hematoma (-), deformity (-).
palpation : Vocal fremitus symmetrically left and right, tenderness (- /
-)
percussion : Resonant in both lung fields
auscultation : Veikular breath sounds right and left, ronkhi (- / -),
wheezing (- / -)
Heart
auscultation : I-II heart sound regular pure, gallops (-), murmur (-)
abdomen
Inspection : Flat, lesion (-), hematoma (-), edema (-)

5
 auscultation : Bowel (+)
palpation : Tenderness of the abdominal wall (-), defans muscular (-)
percussion : Timpani, shifting dullnes (-)
genital
There is no injury, there is no pain
The upper limb
- Akral warm (+ / +), edema (- / -)
lower extremities
- Akral warm (+ / +), edema (+/-)

IV. Localist Status: Regio dorsal pedis dextra

LOOK:
- Looks skin avulsion in the region of the dorsal pedis dextra with a
size of 8 cm x 6 cm x 7cm, deformity (+), edema (+), hematoma (-
), sikatrix (-), active bleeding (-)
- Hecting looked at dorsal pedis situation dextra
FEEL:
- Tenderness (+), felt warm (+), crepitus (+)

ROM
- limited movement due to pain
NVD
- capiilarry refill time<2 seconds
- sensory: Sensitive to palpation (+), pain (+)
- motor : + / +
- Dorsal pedis artery palpable

V. SUPPORTING INVESTIGATION
- Laboratory : (10 - 07- 2018)
o 4:29 RBC x 106 / mm3

6
 o HGB 11.0 g / dL
o HCT 43.9%
o PLT 223 x 103 / mm3
o WBC 15.9 x 103
o GDS 161 mg / dl
o HbsAg (-) Negative
o urea 1.06 mg / dl
o Creatinine 32.7 mg / dl
o Bleeding time 2 minutes
o Clotting time 5 minutes

clinical features

- X- ray

7
 Image: X-ray region dextra pedis AP / Oblique

VI. RESUME
Male patients aged 59 years in with complaints of pain and lacerations on
the right feet and toes felt difficult to move from ± 12 hours before entering the
hospital. Patients in a motorcycle accident at around 12:00 pm. From a physical
examination in the region of the dorsal pedis dextra visible skin evulsi with
hecting situation in the region of the dorsal pedis dextra with a size of 8 cm x 6
cm x 7 cm, deformity (+), edema (+), bone exposure (-), accompanied by
tenderness, ROM limited because of pain, sensory and motor within normal
limits.
In the x-ray radiology examination region dextra pedis AP / Oblique seem
incomplete fracture of metatarsal II os pedis dextra with their joint dislocation
metatarsal II-III.
diagnosis
Open frakture-dislocation of the metatarsal II pedis dextra
(Lisfranc Fracture-dislocation)

Management:

8
 a. medikamentosa
IVFD Futrolit 20 TPM
Inj. Cefobactam 1 g / 12 h / v
Inj. Ketorolac 30mg / 8 hours / iv
Inj. Ranitidine 50mg / 8 hours / iv
- Pro debridement
- Reposition Dislocation
b. Non-medical
 free diet
 Explain to the patient that the patient's family suffered a fractured
right leg
 Consul orthopedic surgeons to handle more
 Explaining the patient's family that needed surgery for further
treatment.

VII.PROGNOSIS : Dubia et Bonam

follow-up
date follow Up
12/07/18 S = Pain in the right leg (+), the fingers are difficult to move (+)
O = BP: 120/80 mmHg
N = 88 x / m
R = 20 x / m
S = 36.3 ° C
Look: deformity (+), edema (+),
Feel: tenderness (+), temperature: warm palpable
Move: ROM: limited, motor: + / +
A = Open frakture dislocation metatarsal II pedis dextra
P = - IVFD RL 20 TPM

- Inj. Cefobactam 1 g / 12 h / v - Consul heart

- Inj Ranitidine 50 mg / 8 hours / IV - Consul anesthesia

9
 - Ketorolac 30 mg / 8 hours / IV
- Debridement plan, repositioning dislocation
07/13/2018 S = Pain in the right upper leg (+), it is difficult to lift, difficult to
move fingers
O = BP: 120/70 mmHg
N = 88 x / m
R = 20 x / m
S = 36.5 ° C
Look: deformity (+), edema (-),
Feel: tenderness (+), temperature: warm palpable
Move: ROM: limited, motor: + / +
A = Open frakture dislocation metatarsal II pedis dextra
P = - IVFD RL 20 TPM
- Inj. Cefobactam 1 g / 12 h / v
- Ranitidine 50 mg / 8 hours / IV
- Ketorolac 30 mg / 8 hours / IV -Konsul anesthesia
- 07/15/2018 debridement plan
- Blood Ready 2 bag PRC
07/14/2018 S = Pain in the right upper leg (+), it is difficult to lift, difficult to
move fingers
O = BP: 120/90 mmHg
N = 86 x / m
R = 20 x / m
S = 36.5 ° C
Look: deformity (+), edema (-),
Feel: tenderness (+),
Move: ROM: limited, motor: + / +
A = Open frakture dislocation metatarsal II pedis dextra
P = - IVFD RL 20 TPM
- Inj. Cefobactam 1 g / 12 h / v

10
 - Inj Ranitidine 50 mg / 8 hours / IV
- Ketorolac inj 30 mg / 8 hours / IV

07/15/2018 Actions carried Surgery Debridement + Repositioning dislocation

Report of surgery:
 Patients with spinal anesthesia supine position
 Asepsis and sterilization procedures performed in the
operating Langan
 Operating field narrowed with sterile Doek
 Debridement was first performed in the area of skin
dorsum of the foot dextra
 Skin necrosis (+) dorsum of the foot
 assess muscle and tendon. Muscle viability was assessed
by 4C, "Color, contractility, Circulation and Consistency.
 Irrigation and wipe with H202 and NaCl
 Reposition the fracture dislocation digiti pedis II Dextra
 Do debridement reset
 Close wond by approximal
 wond dressing
 op completed
07/16/2018 S = Pain in the right upper leg (+), it is difficult to lift, difficult to
move fingers
O = BP: 120/90 mmHg
N = 80 x / m
R = 20 x / m
S = 36.8 ° C
Look: deformity (-), edema (-),
Feel: tenderness (+),
Move: ROM: limited, motor: + / +

11
 A = post Debridement H-1
Open frakture dislocation metatarsal II pedis dextra
P = - RL 20 TPM IVFD
- Inj. Cefobactam 1 g / 12 h / v
- Inj ketorolac 30 mg / 8jm / IV
- Diet when the patient is fully awake

07/17/2018 S = Pain in the right upper leg (+), it is difficult to lift, difficult to
move fingers
O = BP: 120/80 mmHg
N = 88 x / m
R = 20 x / m
S = 36.5 ° C
Look: deformity (+), edema (-),
Feel: tenderness (+),
Move: ROM: limited, motor: + / +
A = post Debridement H-2
Open frakture dislocation metatarsal II pedis dextra
P = - RL 20 TPM IVFD
- Inj. Cefobactam 1 g / 12 h / v
- Inj ketorolac 30 mg / 8jm / IV
- Outpatient

12
 CHAPTER III
DISCUSSION

From the history, physical examination and investigations in this case, the
diagnosis obtained by Open fracture-dislocation of metatarsal II pedis dextra.
The history of the patient pain and lacerations on the upper right leg and
fingers felt difficult to move from ± 12 hours before entering the hospital post
traffic accidents (falls from motorcycles) are caused by the patient hit by another
motorist. The mechanism of trauma where the patient is hit from the right, falling
to the left and head collided with the asphalt. Some time after the fall of patients
calling for help then unconscious. Fainting (+) head injury (+) Nausea (-),
vomiting (+), heartburn (-), BAK (+) smoothly, BAB (+) outstanding.
According to Sachdeva, the cause of the fracture can be divided into
three, namely: 5
a. traumatic injuries
Traumatic injury to the bone can be caused by:
1) Direct injury means a direct blow to the bone so that the bone breaks
spontaneously. The beatings usually causes transverse fractures and damage
to the overlying skin.
2) The injury does not necessarily mean a direct blow to be away from the
location of the impact, for example, fell by hand berjulur and cause a fracture
of the clavicle.
3) Fractures caused by loud sudden contraction of the muscles strong.
b. Pathological fracture
In this case the bone damage due to the disease process in which with minor
trauma can result in fractures can also occur in a variety of circumstances:
1) Bone tumors (benign or malignant): growth of new tissue that is uncontrolled
and progressive.
2) Infections such as osteomyelitis: can occur as a result of an acute infection or
may arise as a progressive process, slow and painful illness.

13
 3) Rickets: a bone disease caused by vitamin D deficiency that affects all other
skeletal tissue, usually caused by a dietary deficiency, but it can sometimes be
caused by failure or by the absorption of Vitamin D for calcium intake or low
phosphate.
The cause of occurrence of fractures in patients with traumatic injury is
direct where a direct hit due to foot rested on the asphalt road and result in broken
bones or dislocated spontaneously fracture in the metatarsal II pedis dextra.
On physical examination, inspection Regio pedis dextra look any open wound
with a sewing conditions, deformities in the pedis dextra, sikatrix (-). Palpation:
tenderness (+), felt warm (+), edema (+), bone exposure (-), ROM: limited
because of pain. NVD: capiilarry refill time <2 seconds. Sensory: sensitive to
palpation (+), pain (+). Motor: + / +.On examination, there crackles on the right
foot. The results of this event depends on (1) the degree of injury, (2) adequate
reduction, and (3) adequate fixation. With the clinical examination, it can be
suspected fracture. Nevertheless, radiological examination is required to
determine the state, as well as the location of the fracture extension.
On radiological examination R. pedis dextra AP / Oblique: fracture-dislocation
of metatarsal II pedis Dextra:

- Pedis radiographs revealed the fracture-dislocation or Lisfranc

tarsometatarsal joints. Diastasis between the proximal metatarsal 1 and 2,
2 and 3 visible and show injuries stabil. A bone fragments present in this
area because the Lisfranc ligament avulsion. In addition, the lateral edge of
the medial cuneiform is not parallel to the lateral aspect of the medial

14
 cuneiform metatarsal pertama.dan lateral edges are not aligned with the
medial aspect of the second metatarsal. Then the surrounding soft tissue
swelling impression. This malalignment may be the only indication of
injury to the Lisfranc joint in a more subtle presentation, which can be
easily misdiagnosis.4
- A good approach of radiographic foot should incorporate a phased
approach to its interpretation. The ABCs mnemonic of A (alignment), B
(bone), C (cartilage) and S (soft tissue) can be used in the interpretation of
radiographs of the feet and other radiographic images in the body. Start by
assessing alignment (A) of TMTJ with:
▸Draw a line along the axis of the base of the second metatarsal and
medial to the medial side in the middle hue AP movies.
▸ Drawing a line between the medial side of the shaft and the base
of the fourth metatarsal and medial sides of the cuboid.
▸ Assessing widening the interval between the first and second beam ≥ 2.7
mm.
▸ Metatarsal dorsal subluxation in lateral view.

15
 The audit findings in Lisfranc injury can vary that pose a challenge for
early assessment and diagnosis. Ecchymosis plantar arch is considered
pathognomonic for Lisfranc injury, but may not be present in the sample ligament
strain or minor fractures. However, no studies that assess the positive predictive
value of this marker, and the evidence for its significance seemed anecdotal to
date ini.5
If there is suspicion of a leg injury, plain radiographs should be performed.
After a high-speed trauma, patients may present with severe swelling on the
middle leg and dilation or leveling feet are related. Soft tissue injuries such as
open fractures with skin deficits and injury to the dorsal padis may also occur. In
extreme cases, compartment syndrome can occur, and this is best assessed
through the elicitation of pain out of proportion to the passive stretching toes.
Typically, the patient's feet are too swollen or too soft for the appropriate
investigations to the various movements of the midfoot. In subacute or delayed
presentation, specific tests for Lisfranc injuries including instability test; where
TMTJ can dorsal dorsal subluks with power application to the distal aspect of the

16
midfoot. In severe cases can also occur medial and lateral shift of the first and
second metatarsal, and this is generally an indication for urgent surgical
intervention. Provocative test can also be used, in which the abduction of the
forefoot pronation and creates a feeling of sakit.5
CLASSIFICATION
A number of classification systems have been proposed for Lisfranc
fracture dislocation based mechanisms by which the injury sustained. The latest
and accepted was designed by Myerson et al, which helps improve Lisfranc
injuries by helping clinical decision making.
fracture illustrated by the difference in the first and second metatarsal
intervals either the medial or lateral direction. Type A fracture indicates a
discrepancy in total on TMTJ; fracture type B indicates a discrepancy partial of
the first rays of the insulation (incompatibility medial partial) or the rest of the
lateral four-rays (mismatch lateral partial) and fracture type C develops
divergence in the beam first and second with one (C1) or total (C2) displacement.
4

17
 In these patients required subsequent laboratory examination as
pemeruksaan investigation to determine whether there are signs of infection or
whether there are things that can cause obstruction surgery Laboratory tests
include:
a. Routine blood tests for the general situation, an acute infectious / chronic
b. on specific indications: the necessary blood chemistry, immunological
reactions, liver / kidney

In laboratory tests showed

o 4:29 RBC x 106 / mm3
o HGB 11.0 g / dL
o HCT 43.9%
o PLT 223 x 103 / mm3
o WBC 15.9 x 103
o GDS 161 mg / dl
o HBsAg (-) Negative
o 1:06 urea mg / dl
o Creatinine 32.7 mg / dl
o Future bleeding 2 minutes
o Freezing period 5 minutes

It showed no complications in the operation due to abnormal patient lab

results.
As for the management of patients is preoperative and postoperative
administration of medical form of antibiotics and anti-pain, at the time before the
surgery the patient is given cefobactam, ranitidine, and ketorolac it within their
theories and condition of the patient where the patient has signs open fracture that
required antibiotics, antibiotics then performed before patients underwent surgery
this is in accordance with the theory of the research that has been done in the
journal kumar india as follows:

18
1. Antibiotics (prophylaxis), is antibiotics given before surgery or immediately in
case of clinically not show signs of infection. It is expected that during the
operation of the network, the target already contain high levels of certain
antibiotics are effective to inhibit the growth of bacteria or kill germs.
Antibiotic prophylaxis in surgery is an antibiotic given to patients who
undergo surgery before the infection, the goal is to prevent infection from the
surgery terjaidnya ie wound infections (ILO) or surgical site infection (SSI).
The ILO can be divided into three categories: superficial covering the skin and
subcutaneous tissue, which includes the deep fascia and muscles, and orgayn /
space that includes organs and cavities tubuh.10

Selective antibiotic are selected, inexpensive, non-toxic, narrow spectrum.

Gram-positive organisms Staphylococcus aureus and epidermidis usually most
commonly associated with infection in orthopedics. Generally, these
organisms are normal flora in the skin and can be attached to the implant and
bermultipikasi. Preoperative antibiotics inserted so that is a beta lactam group
such as cephalosporin, penicillin and derivatives cloxacilin, glycopeptides
such as Teicoplanin and aminoglycosides such as gentamicin. According to
the American Society of Health System Pharmacist (ASHP), cefazolin was
used as a preoperative prophylactic cefazolin combination with gentamicin
has been widely used as antibiotics rationally in orthopedic surgery. While the
two-generation cephalosporins cefuroxime which is used in 11 8 cases who
underwent arthroplasty procedure. While the third generation cephalosporins
are used for the installation of internal fixation. In this use case cefobactam
sefalosforin third generation which is suitable for orthopedic surgery. 10

2. Analgesic
Analgesics preempetif inserted before the painful stimulus can prevent or
substantially mererduksi pain. Analgesics or pain medication is a substance - a
substance that can mengurngi ataumenghilangkan pain without losing
consciousness (the difference with general anesthetics). Analgesics are
classified based on their mechanism of action: namely:

19
  Emphasis raasa merintani pain with stimulus formation in the peripheral
pain receptors (peripheral analgesic, local anesthetic)
 Pressing pain by blocking pain stimuli in nerve distribution - sensory
nerve (local anesthesia)
 Block pain in a pain center of the central nervous system (narcotic
analgesics, general anesthetics) .9,10
In this case the patient is given an analgesic such as ketorolac combined
with ranitidine. Where is the analgesic ketorolac. Yet another effect that appears
when analgesics without reducing stomach acid, the patient will be pain in the
upper abdominal area or could also feel a burning sensation in the pit of her
stomach. The side effects of gastric acid Ketorolac is raised, then to reduce
stomach acid, ranitidine chosen as lowering levels of stomach acid.
Lisfranc fracture-dislocation is rare, but should be suspected in a high-
energy injuries, such as motor vehicle collisions and falls, as well as sports that
involve fixation of the forefoot (horseback riding, windsurfing). They can lead to
lower energy mechanism, such as trips and falls. Any alleged Lisfranc fracture
dislocations require orthopedic consultation for treatment require fixation
operatif.5
Lisfranc stable can be treated non-operatively; usually in a non-weight
bearing short below-knee cast for a period of 6 weeks. Stability should generally
be rechecked at 10-14 days with radiographic signs of heavy loads and if the
collapse or loss of fixation operative position is observed then consideration.
Unstable fracture dislocation, on the contrary has been shown to have poor
outcomes when treated with reduction and casting. Like most lower limb injury,
immediate management and icing involves the improvement of the extremities, to
try and limit the swelling and reduce inflammation lokal.4

20
Complications of Lisfranc fracture: 5
1. compartment syndrome
2. Cellulitis / wound infection
3. Contractures (especially if the skin grafts needed to cover open wounds)
4. Vascular injury: dorsalis pedis artery is often compromised (mutiple
branch ant / post tibial A. usually not a problem)
5. The superficial peroneal nerve palsy
6. Post-traumatic arthritis (depending on the injury to the articular cartilage
and the failure to achieve anatomic reduction)
7. Damage to the hardware / screw broken
8. Postraumatik deformity (usually planovalgus) with difficulty wearing
shoes.
9. Malunion (dorsolateral corner tarsometatarsal joint second most common).
10. nonunion

21
 CONCLUSION
Lisfranc injury is a fracture dislocation of the midfoot. The mechanism of
injury can vary from simple to the distension of high-energy trauma. Early
diagnosis is very important right. There is no absolute consensus on the definitive
treatment, however, closed reduction and K-wire fixation should be avoided.
Open reduction and internal screw fixation or primary arthrodesis of the medial
column and center, especially on pure ligament injury, is recommended.

22
 BIBLIOGRAPHY
1. Chairuddin R. Introduction Orthopedic Surgery. Makassar: Stars
Lamumpatue; 2010
2. Mikko Kirjavainen, MD, PhD, 2011, Lisfranc injuries, Department of
Orthopedics and Traumatology Helsinki University Central Hospital,
Helsinki Finland. Ortopedia ja Suomen Traumatologia Vol. 34.
Fromhttp://www.soy.fi/files/sot_1_2011_11.pdf, 2011, 58-62.
3. Pearce, Evelyn. C. (2006); "Anatomy and Physiology for Paramedics",
PT.Gramedia Pustaka Utama, Jakarta.
4. Simon Lau, Michael Bozin, Tharsa Thillainadesan, 2015, the Lisfranc
fracture dislocation: a review of a commonly missed injury of the midfoot.
Emerg Med J 2017; 34: 52-56. doi: 10.1136 / emermed-2015-205317.
5. Joel M. Schofer, Sean O'Brien, 2008. Images in Emergency Medicine:
Lisfranc Fracture-dislocation. Department of Emergency Medicine, Naval

23
 Hospital Okinawa. West JEM. 2008; 9: 56-57. open access at
www.westjem.org
6. Chairuddin R. Introduction Orthopedic Surgery. Makassar: Stars
Lamumpatue; 2013
7. Hansen, John T. 2010. Netter Clinical Anatomy. 2nd Ed. Philadelphia:
Saunders
8. Egol, KA, Koval, KJ, Zuckerman JD Handbook Of Fractures. Philadelphia:
Lippincott Williams & Wilkins. 2010: p. 193-229; 604-614
9. Noor Helmi, Zairin, 2012; Textbook of Musculoskeletal Disorders; vol 1,
Salemba Medika, Jakarta,
10. Kumar et al, 2015. Prophylactic antibiotics in orthopedic surgery:
Controversy its use, Indian Journal of Orthopedics, Volume 4, India.
11. Lawrence A. Di Domenico, DPMA, Davi Cross, 2012 Tarsometatarsal /
Lisfranc Joint. Clin Podiatr Med Surg 29 (2012) 221-242 doi: 10.1016 /
j.cpm.2012.01.003.http://podiatric.theclinics.com,

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