Description and Demonstration of a Novel Technique Utilizing a Modified Quigley Maneuver for Reduction of Lisfranc Injury and Midfoot Dislocations

Abstract

The Lisfranc ligament joint complex is comprised of the base of the second metatarsal, the lateral facet of the medial cuneiform, the first and second tarsometatarsal joints, as well as the ligaments spanning the joint. Lisfranc injuries have been reported as one of the most commonly misdiagnosed foot injuries in both the emergency and outpatient settings. These injuries tend to involve the ligamentous structures but can also be associated with fracture and/or dislocation. The mechanism of injury can be both high and low energy.  The lower energy mechanism of Lisfranc injury is commonly a result of the foot dynamic twisting or abduction, creating excessive stress on the ligaments and bones of the midfoot. When displaced, potential injury or impingement on neurovascular structures may warrant an immediate closed reduction, as it is important to achieve near anatomic alignment to prevent skin necrosis or neurovascular complications.

This manuscript presents the novel use of a widely accepted distraction technique used for ankle fracture reduction, modified to allow the reduction of midfoot joint dislocations. Utilizing a gauze roll and an IV pole, both of which are readily available in the clinical and emergency department setting, this technique has proven successful in clinical practice without resultant complications. A gauze roll is affixed to the first and second digit to provide axial traction at the second metatarsal. The free ends are then attached to a point of stability and the foot is placed in gravity-assisted traction. A reduction of the Lisfranc dislocation is then obtained by traction of the second metatarsal via an indirect focus at the central point of instability within the midfoot. This injury can then be immediately splinted in this reduced position to provide stability until operative fixation can be achieved.

The use of the modified Quigley maneuver is highly efficient in reducing displaced Lisfranc injuries and midfoot dislocations. With simple modifications of the previously described technique, near-anatomic reduction of midfoot dislocations can be achieved without the need for more invasive techniques currently described in literature. This technique provides the practitioner with an additional tool to safely stabilize this inherently unstable injury until more appropriate intervention can be performed.