Trimalleolar fracture associated to a Lisfranc dislocation: A case about a rare association

Trimalleolar ankle fractures represent severe rotational injuries that frequently require operative management to restore joint stability and prevent long-term functional impairment. Lisfranc injuries, involving disruption of the tarsometatarsal joint complex, are less common and often underdiagnosed. The simultaneous occurrence of these two injuries is exceptionally rare and reflects a high-energy trauma mechanism combining rotational and axial forces.

We report the case of an 18-year-old male who sustained a high-energy motor vehicle accident resulting in a displaced trimalleolar ankle fracture associated with a Lisfranc dislocation. Clinical examination revealed significant ankle deformity and midfoot tenderness. Radiographs and computed tomography confirmed both injuries. The patient underwent single-stage surgical management consisting of open reduction and internal fixation of the ankle fracture, along with anatomical reduction and stabilization of the Lisfranc joint complex using Kirschner wires. Postoperative management included strict non–weight-bearing immobilization followed by progressive rehabilitation.

This case highlights the importance of systematic evaluation of the entire foot and ankle in high-energy trauma, as concomitant midfoot injuries may be overlooked. Early recognition and precise anatomical reduction of both lesions are critical to optimize functional outcomes and minimize long-term complications such as post-traumatic arthritis and chronic midfoot instability.