An old mismanaged Lisfranc injury treated by gradual deformity correction followed by the second-stage internal fixation

Abstract

The Lisfranc fracture-dislocation of the foot is uncommon and diagnosis is often missed. The Lisfranc joint involves the articulation between medial cuneiform and base of the second metatarsal and is considered a keystone to structural integrity to the midfoot. The articulation has a stabilization effect on longitudinal and transverse arches of the foot. A neglected or untreated injury to the Lisfranc joint can lead to secondary arthritis and significant morbidity and disability. We present a case of a neglected Lisfranc fracture-dislocation in a 28-year-old female patient who presented 3 months after injury. A staged treatment of distraction with an Ilizarov ring fixator followed in the second stage by the removal of ring fixator and internal fixation with K wires was performed. There was complete relief of pain and a good functional outcome at 3 months after treatment.

Concomitant old complex fracture–dislocation of the first metatarsophalangeal, Lisfranc, and naviculocuneiform joints

“…10 Several surgical techniques have been described for old midfoot injuries such as open reduction and internal fixation, arthrodesis, and staged management using external fixators as distractor followed by open reduction and internal fixation. 10,11 While the presented case had been admitted in an ICU for about 2 months, the surgeon and nurses had not been aware of possible foot injuries, although ankle foot orthosis had been applied during his admission in the ICU. As it was an old complex injury with involvement of different parts of the foot and cartilage loss in the joints, it was decided to do reconstructive arthrodesis instead of staged management to preserve the joints.…”

Partial Extensor Hallucis Longus Injury Following Lisfranc Fixation Loosening

“…In the event of hardware failure, a plate is easier to remove and less likely to cause articular damage in the interim period between failure and surgical removal. Conversely, removal is often necessary, as spanning the tarsometatarsal joint often causes appreciable restriction of the midfoot range of motion [ 1 - 2 , 11 ]. The requirement to contour each plate also increases operating room time.…”

“…Significant damage to the Lisfranc joint is uncommon, with a reported incidence of one per 55,000 individuals, or approximately 0.2% of all orthopaedic traumatic injuries [ 1 , 6 - 7 , 9 ]. The majority of injuries result from high-energy forces, though occasionally they originate from a less traumatic mechanism such as a fall with rotational forces on a hyperplantar-flexed foot [ 10 - 11 ].…”

“…Post-traumatic arthritis is the most common complication [ 4 ]. Additional documented sequelae include complex regional pain syndrome, pes planus, neuromas, infections, and vascular injuries [ 11 , 13 ].…”