DEX IOT DAY 4 TEST 2025 | MIDFOOT & FOREFOOT | (
QUESTIONS AND WELL DETAILED ANSWERS) |
GRADED A+ | LATEST UPDATE 2025/2026
Where is the lisfranc joint? -CORRECT ANSWER Spans the entire midfoot articulation
with the metatarsals
What is the keystone conformation? -CORRECT ANSWER Connection between 2nd
met and middle cuneiform that provides stability to lisfranc joint
What does the lisfranc ligament connect? -CORRECT ANSWER Medial cuneiform to
base of 2nd met
Three aspects of lisfranc ligament: -CORRECT ANSWER Dorsal, interosseous, plantar
What makes up the lisfranc complex? -CORRECT ANSWER 1st and 2nd met & medial
and middle cuneiform
What type of injury typically causes instability and gapping between bones of lisfranc
complex? -CORRECT ANSWER Axial load
Which column of the foot has the most flexibility? -CORRECT ANSWER Lateral column
What mechanisms of injury occur with lisfranc pathology? -CORRECT ANSWER Direct
or indirect, high energy or low energy
What constitutes a direct injury? -CORRECT ANSWER axial load with dorsal and
plantar forces
What constitutes an indirect injury? -CORRECT ANSWER Plantarflexed foot with axial
load (heavy object falling on foot- tarsals shift anterior or posterior)
What is necessary to diagnose lisfranc injury? -CORRECT ANSWER Weightbearing x-
ray
What is a fleck sign? -CORRECT ANSWER Avulsion fracture between 2nd met and
medial cuneiform
What type of lisfranc injuries do not require surgery? -CORRECT ANSWER
Nondisplaced and stable
, Lisfranc stability relies on ____ anatomy, while displacement relies on _____ anatomy -
CORRECT ANSWER Ligamentous, bony
What is a downside of fixing/fusing lisfranc injury with screws? -CORRECT ANSWER
No micromotion - they can break
What is a benefit of lisfranc ORIF with plates? -CORRECT ANSWER Plate fixation
maintains stability without violating the articular surface
What is ligamentous lisfranc augmentation (mini tightrope, internal brace) typically
indicated for? -CORRECT ANSWER Low energy injuries, mostly young adults and
highly active individuals
What is the gold standard for lisfranc injury fixation? -CORRECT ANSWER Plates and
screws
What % of all fractures are lisfranc injuries? -CORRECT ANSWER 0.2%
Who treats most lisfranc injuries? -CORRECT ANSWER Sports surgeons
What is the role of hardware in ORIF? -CORRECT ANSWER Maintains reduction,
hardware eventually removed
Role of hardware in fusion? -CORRECT ANSWER Compresses fusion, hardware left in
place
What are lisfranc (diamond) plates indicated for? -CORRECT ANSWER Fixation or
fusion; high or low energy injuries; orientations left and right; sizes S,M,L; oblong
compression hole across lisfranc joint placed on 2nd met, other holes take 3.5
Lisfranc Internal Brace: -CORRECT ANSWER Purely ligamentous injuries, ideal for
athletes; cons: difficult to tension properly, can be difficult for soft bone; benefits: low-
profile fixation, strong biomechanical data (multi-plane fixation)
Knotless Mini Tightrope: -CORRECT ANSWER Purely ligamentous injuries, ideal for
athletes; alternative for those that struggle with IB; cons: medial button prominence;
benefits: knotless and tensionable, no change in surgical technique (6 strand #2
coreless machine suture)
Supplemental internal brace fixation in intercuneiform joint creates a ______ stronger
construct across Lisfranc complex -CORRECT ANSWER 2x
For ligamentous injuries, fixation into medial cuneiform is comparable to -CORRECT
ANSWER Using a cannulated screw
QUESTIONS AND WELL DETAILED ANSWERS) |
GRADED A+ | LATEST UPDATE 2025/2026
Where is the lisfranc joint? -CORRECT ANSWER Spans the entire midfoot articulation
with the metatarsals
What is the keystone conformation? -CORRECT ANSWER Connection between 2nd
met and middle cuneiform that provides stability to lisfranc joint
What does the lisfranc ligament connect? -CORRECT ANSWER Medial cuneiform to
base of 2nd met
Three aspects of lisfranc ligament: -CORRECT ANSWER Dorsal, interosseous, plantar
What makes up the lisfranc complex? -CORRECT ANSWER 1st and 2nd met & medial
and middle cuneiform
What type of injury typically causes instability and gapping between bones of lisfranc
complex? -CORRECT ANSWER Axial load
Which column of the foot has the most flexibility? -CORRECT ANSWER Lateral column
What mechanisms of injury occur with lisfranc pathology? -CORRECT ANSWER Direct
or indirect, high energy or low energy
What constitutes a direct injury? -CORRECT ANSWER axial load with dorsal and
plantar forces
What constitutes an indirect injury? -CORRECT ANSWER Plantarflexed foot with axial
load (heavy object falling on foot- tarsals shift anterior or posterior)
What is necessary to diagnose lisfranc injury? -CORRECT ANSWER Weightbearing x-
ray
What is a fleck sign? -CORRECT ANSWER Avulsion fracture between 2nd met and
medial cuneiform
What type of lisfranc injuries do not require surgery? -CORRECT ANSWER
Nondisplaced and stable
, Lisfranc stability relies on ____ anatomy, while displacement relies on _____ anatomy -
CORRECT ANSWER Ligamentous, bony
What is a downside of fixing/fusing lisfranc injury with screws? -CORRECT ANSWER
No micromotion - they can break
What is a benefit of lisfranc ORIF with plates? -CORRECT ANSWER Plate fixation
maintains stability without violating the articular surface
What is ligamentous lisfranc augmentation (mini tightrope, internal brace) typically
indicated for? -CORRECT ANSWER Low energy injuries, mostly young adults and
highly active individuals
What is the gold standard for lisfranc injury fixation? -CORRECT ANSWER Plates and
screws
What % of all fractures are lisfranc injuries? -CORRECT ANSWER 0.2%
Who treats most lisfranc injuries? -CORRECT ANSWER Sports surgeons
What is the role of hardware in ORIF? -CORRECT ANSWER Maintains reduction,
hardware eventually removed
Role of hardware in fusion? -CORRECT ANSWER Compresses fusion, hardware left in
place
What are lisfranc (diamond) plates indicated for? -CORRECT ANSWER Fixation or
fusion; high or low energy injuries; orientations left and right; sizes S,M,L; oblong
compression hole across lisfranc joint placed on 2nd met, other holes take 3.5
Lisfranc Internal Brace: -CORRECT ANSWER Purely ligamentous injuries, ideal for
athletes; cons: difficult to tension properly, can be difficult for soft bone; benefits: low-
profile fixation, strong biomechanical data (multi-plane fixation)
Knotless Mini Tightrope: -CORRECT ANSWER Purely ligamentous injuries, ideal for
athletes; alternative for those that struggle with IB; cons: medial button prominence;
benefits: knotless and tensionable, no change in surgical technique (6 strand #2
coreless machine suture)
Supplemental internal brace fixation in intercuneiform joint creates a ______ stronger
construct across Lisfranc complex -CORRECT ANSWER 2x
For ligamentous injuries, fixation into medial cuneiform is comparable to -CORRECT
ANSWER Using a cannulated screw
