Fracture Dislocations of the Tarsometatarsal Joints: End Results Correlated with Pathology and Treatment

Abstract

Seventy-two patients with 76 fracture-dislocations of the Lisfranc tarsometatarsal joint complex were evaluated. Fifty-eight (81%) were polytrauma patients and the remainder suffered isolated injuries. Sixty of the original 72 patients were available for long-term study. Eight of these had an amputation at or shortly after the original admission, leaving 52 patients with 55 Lisfranc injuries for analysis. The average length of follow-up was 4.2 years (range, 20 months to 11 years). According to the Painful Foot Center scoring system, 27 feet (49%) achieved an excellent or good result and 28 (51%), a fair or poor result. Direct crush injuries did poorly with only one of eight scoring good or excellent. Of the various treatment modalities, open reduction and internal fixation with Kirschner wires yielded the best results. The major determinant of unacceptable results was identified as the quality of the initial reduction. Tarsal instability and late degenerative joint disease caused most of the symptoms. Twenty-three of the 52 patients (44%) have had or should have further mid-foot surgery to improve function and comfort. Because our results were often poor, our present protocol includes closed or open reduction and Kirschner wire internal fixation. Displacement greater than 2 mm or a talometatarsal angle greater than 15 degrees on radiographs following a closed reduction mandates open reduction.

Does Open Reduction and Internal Fixation versus Primary Arthrodesis Improve Patient Outcomes for Lisfranc Trauma? A Systematic Review and Meta-analysis

“…It has been demonstrated that anatomic reduction and rigid stabilization of the Lisfranc complex is the standard of care for these injuries [27]. Open reduction and internal fixation (ORIF) and primary arthrodesis have both been evaluated as treatment options with acceptable results [18].…”

Outcome of surgically treated Lisfranc injury: A review of 34 cases

“…[1] We used the Modified Hardcastle Classification [7] for this study (Table 1). Patients were then contacted for further evaluation, and all data were entered in the data collection form.…”

A Lisfranc Fracture-Dislocation in a Football Player

“…2,4,12 Most investigators have concluded that there is little place for the nonoperative management of Lisfranc fracture-dislocations when a 2-mm or greater diastasis is found between the bases of the first and second metatarsals and medial and middle cuneiforms, because it is difficult to maintain anatomic reduction by closed reduction and immobilization alone. 1,2,4,5,7,9,14,15 Curtis et al 16 recommend surgical reduction for all athletes and active persons. Surgical reduction as soon as possible after the injury is recommended by most orthopaedic surgeons.…”

“…12 Closed or open reduction with Kirschner wire (K wire) internal fixation has historically been used for the treatment of these injuries. 14 The use of open reduction and internal fixation with AO screws (meets Arbeitsgemeinschaft fü r Osteosynthesefragen international standards) has grown increasingly popular for Lisfranc fracture-dislocations. 12 After screw fixation, most orthopedists recommend immobilization and non-weight-bearing status for 8 to 12 weeks.…”