# Myerson Lisfranc — Original Myerson-modified Hardcastle classification of Lisfranc fracture-dislocations

> Per-foot morphology classification of displaced tarsometatarsal fracture-dislocations into total incongruity, medial or lateral partial incongruity, and partial or total divergence. The original five-pattern system communicates displacement topology but does not encode subtle-injury stability, ligament integrity, treatment indication or prognosis by itself.

**Situação:** vigente · **Órgão:** Musculoesquelético · **Órgão emissor:** Myerson, Fisher, Burgess and Kenzora · **Versão:** Original 1986 five-pattern A-C system; later type D kept separate · **Ano:** 1986

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: XR, CT
- Fonte primária: Myerson MS, Fisher RT, Burgess AR, Kenzora JE. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment (1986) — https://pubmed.ncbi.nlm.nih.gov/3710321/
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Use the original five A-C patterns only, pair every code with anatomy, and keep subtle-injury stability, later type D, prognosis and treatment as separate layers.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| A | Type A, total incongruity | Total incongruity: the bases of all five metatarsals are displaced together in the same direction, classically homolateral lateral displacement but potentially dorsoplantar displacement. This is a displacement pattern of the entire tarsometatarsal complex, not merely widening of the Lisfranc interval. | Obtain urgent foot-and-ankle specialist assessment and separately report reduction status, soft-tissue condition, fractures, comminution, neurovascular findings and physiologic stability. A displaced total-incongruity injury commonly requires reduction and stabilization, but the A label alone does not select fixation versus fusion or dictate timing; threatened skin, open injury, compartment syndrome or neurovascular compromise drives urgent action independently. | The pattern represents extensive tarsometatarsal incongruity, but no validated contemporary probability of arthritis, fusion, reoperation or functional loss belongs to type A alone. In the historical 1986 cohort, reduction quality and late instability or degeneration were major outcome determinants across types; those center-era results cannot be converted into an individual type-A forecast. | Myerson et al. 1986, DOI 10.1177/107110078600600504, primary A-C classification and outcome discussion; Siddiqui et al. 2014, DOI 10.1148/rg.342125215, Myerson Table 2 and total-incongruity description; current ACR Acute Trauma to the Foot for imaging escalation. | ✓ |
| B1 | Type B1, medial partial incongruity | Partial or isolated incongruity with medial displacement of the first metatarsal base at the first tarsometatarsal joint, while the lateral four metatarsal bases are not part of a divergent displacement pattern. Confirm the first-ray direction across adequate projections rather than inferring B1 from an isolated fracture. | Describe first-ray displacement, articular injury, reducibility, ligamentous and bony components and any instability under load when that can be assessed safely. Specialist management depends on true displacement or instability, cartilage injury, soft tissue and patient context. The morphology code supports planning but does not autonomously mandate one operation, and a reduced injury can remain unstable despite losing the original B1 appearance. | B1 has no portable per-type risk percentage. A partial pattern can be clinically consequential despite involving fewer rays, and missed or inadequately reduced instability can lead to painful post-traumatic degeneration. Prognosis depends more directly on recognition, anatomic alignment, ligament and cartilage injury, energy, treatment and follow-up than on the B1 token by itself. | Myerson et al. 1986, primary partial-incongruity framework; Siddiqui et al. 2014, Myerson Table 2, isolated first-tarsometatarsal displacement; Mahmoud et al. 2015 and Engelmann et al. 2023 for limits of observer reliability and applicability. | ✓ |
| B2 | Type B2, lateral partial incongruity | Partial or isolated incongruity with lateral displacement of one or more of the lateral four metatarsal bases, M2 through M5, without medial displacement of M1 creating divergence. State which rays and tarsometatarsal joints are involved because the same B2 code can represent different anatomic extents. | Report the involved lateral rays, occult fractures or comminution on CT when relevant, and assess first-ray position carefully because uncertain medial M1 displacement creates the B2-versus-C1 boundary. Management is based on displacement and instability, bony versus ligamentous anatomy, reducibility and patient factors; do not turn B2 into a universal procedure or infer stability from nonweightbearing alignment alone. | B2 can be subtle and therefore vulnerable to delayed recognition, but the classification supplies no validated B2-specific probability of poor outcome. Later series have not produced a universally transportable per-type prognosis. Preserve detection confidence, alignment, instability, cartilage injury and treatment quality rather than telling an agent that B2 is intrinsically the best or worst outcome group. | Myerson et al. 1986, primary partial-incongruity classification; Siddiqui et al. 2014, Myerson Table 2 and discussion of lesser-metatarsal displacement; ACR Acute Trauma to the Foot Variant 5 for CT or MRI when radiographs are normal or equivocal. | ✓ |
| C1 | Type C1, partial divergence | Partial divergent incongruity: M1 is displaced medially while fewer than all four lateral metatarsal bases are displaced laterally. The divergence direction and the count of affected lateral rays distinguish C1 from B2 and C2; when M1 direction or the full lateral column is not evaluable, retain that boundary uncertainty. | Divergence generally warrants prompt specialist review, careful soft-tissue assessment and anatomic characterization for reduction and stabilization planning. The code does not select a specific operation. CT can map fractures and comminution, while weightbearing evaluation or MRI may be needed for a separate stability or ligament question when safe and clinically appropriate. | C1 communicates a divergent injury but is not a calibrated risk stratum. Extent of joint involvement, high-energy or crush mechanism, articular damage, persistent instability, reduction quality and complications dominate outcome. Historical aggregate outcomes from displaced injuries and modern reliability studies must not be represented as a C1-specific probability. | Myerson et al. 1986, primary divergent subdivision; Siddiqui et al. 2014, Myerson Table 2, M1 medial with partial lateral-ray divergence; Mahmoud et al. 2015 and Engelmann et al. 2023 for reliability context. | ✓ |
| C2 | Type C2, total divergence | Total divergent incongruity: M1 is displaced medially and all four lateral metatarsal bases, M2 through M5, are displaced laterally. This differs from type A because the rays diverge rather than moving together in one homolateral direction. | Provide urgent specialist assessment, describe full-column displacement, fractures, articular comminution, soft-tissue threat, reduction status and associated injuries, and act immediately on open injury, neurovascular compromise or compartment syndrome. Extensive divergence often requires operative restoration of alignment, but C2 alone does not determine fixation method, fusion, timing or prognosis. | C2 denotes extensive divergent incongruity and plausibly high anatomic burden, yet the system contains no validated C2-specific rate of amputation, arthritis, fusion or disability. In the original high-energy cohort, direct crush injury and inadequate alignment were adverse across the series. Mechanism, soft tissue, cartilage, reduction and rehabilitation must remain explicit risk inputs. | Myerson et al. 1986, primary C2 definition and historical pathology, treatment and outcome correlations; Siddiqui et al. 2014, Myerson Table 2, complete divergent pattern; current ACR imaging pathway for unresolved or occult injury. | ✓ |

### Citações por categoria
- **A**: Myerson MS, Fisher RT, Burgess AR, Kenzora JE. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment (1986) — https://pubmed.ncbi.nlm.nih.gov/3710321/ · Myerson et al. 1986, DOI 10.1177/107110078600600504, primary A-C classification and outcome discussion; Siddiqui et al. 2014, DOI 10.1148/rg.342125215, Myerson Table 2 and total-incongruity description; current ACR Acute Trauma to the Foot for imaging escalation.
- **B1**: Myerson MS, Fisher RT, Burgess AR, Kenzora JE. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment (1986) — https://pubmed.ncbi.nlm.nih.gov/3710321/ · Myerson et al. 1986, primary partial-incongruity framework; Siddiqui et al. 2014, Myerson Table 2, isolated first-tarsometatarsal displacement; Mahmoud et al. 2015 and Engelmann et al. 2023 for limits of observer reliability and applicability.
- **B2**: Myerson MS, Fisher RT, Burgess AR, Kenzora JE. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment (1986) — https://pubmed.ncbi.nlm.nih.gov/3710321/ · Myerson et al. 1986, primary partial-incongruity classification; Siddiqui et al. 2014, Myerson Table 2 and discussion of lesser-metatarsal displacement; ACR Acute Trauma to the Foot Variant 5 for CT or MRI when radiographs are normal or equivocal.
- **C1**: Myerson MS, Fisher RT, Burgess AR, Kenzora JE. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment (1986) — https://pubmed.ncbi.nlm.nih.gov/3710321/ · Myerson et al. 1986, primary divergent subdivision; Siddiqui et al. 2014, Myerson Table 2, M1 medial with partial lateral-ray divergence; Mahmoud et al. 2015 and Engelmann et al. 2023 for reliability context.
- **C2**: Myerson MS, Fisher RT, Burgess AR, Kenzora JE. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment (1986) — https://pubmed.ncbi.nlm.nih.gov/3710321/ · Myerson et al. 1986, primary C2 definition and historical pathology, treatment and outcome correlations; Siddiqui et al. 2014, Myerson Table 2, complete divergent pattern; current ACR imaging pathway for unresolved or occult injury.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-08-12 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-11 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-10 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-09 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-08 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-07 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-06 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-05 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-04 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-03 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-02 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-01 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-31 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-30 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-29 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-28 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-27 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-26 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2018-02-13 | revised | Sivakumar and colleagues proposed type D for subtle Lisfranc injuries, with D1 and D2 stability categories and D2L/D2B subtypes; this event is tracked as a noninterchangeable extension rather than silently altering the original five-code output. | confirmed |
| 1986-04-01 | published | Myerson, Fisher, Burgess and Kenzora published the five-pattern A, B1, B2, C1 and C2 modification of the Hardcastle Lisfranc fracture-dislocation framework. | confirmed |


---
> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

Página HTML: https://radcommons.laudos.ai/systems/myerson-lisfranc · JSON da API: https://radcommons.laudos.ai/api/v1/systems/myerson-lisfranc · Índice para agentes: https://radcommons.laudos.ai/llms.txt