Severe open Lisfranc injuries: one-stage operation through internal fixation associated with vacuum sealing drainage

Abstract

BackgroundThis study aimed to investigate the clinical feasibility of treating severe open Lisfranc injuries by means of one-stage internal fixation with k-wires associated with vacuum sealing drainage (VSD).MethodsThe clinical outcomes of 20 cases of severe open Lisfranc joint fracture-dislocation treated by using one-stage internal fixation with k-wires associated with VSD, after debridement and suturing during emergency treatment, were reviewed.ResultsAt 6 and 12 months after surgery, the American Orthopaedic Foot and Ankle Society midfoot scores were 69.2 and 78.2, the positive rates were 75 and 85 %, and the average visual analogue scale scores were 4.3 and 1.3, respectively. The average time of internal fixation surgery was 47 min (30–70 min). There were three cases of wound-edge necrosis; however, there were no cases of skin necrosis around the incision, or deep infection. The mean time of first hospital stay was 16.1 days (10–23 days).ConclusionsTreatment of severe open Lisfranc fracture and dislocation through one-stage internal fixation with k-wires in association with VSD led to fast anatomical reduction, stabilized bony structure, fast soft tissue recovery, and good short-term follow-up results.

Three-Stage Masquelet Technique and One-Stage Reconstruction to Treat Foot and Ankle Tuberculosis

“…The VSD technique, used for removing infectious and necrotic substances and promoting the presence of various growth factors in wounds, can facilitate wound recovery and is widely used as an assistive therapy combined with surgery for various infections and open trauma. 21,24,26 In addition, several surgeons applied it to TB infections in deep tissue and TB infections with sinus tracts. 13,32 In Jia's study, 13 the median healing time was 19.6 days for 38 patients in the experimental group, which was apparently shorter than for the control group, indicating that VSD is conducive to wound healing and controlling TB with sinus tracts.…”

Modified Dorsal Approach in the Management of Lisfranc Injuries

“…These rates are comparable to those in the literature of 0% to 9% superficial infection and 0% to 13% delayed healing. 7,12,13,17,19,25,29,[31][32][33] The majority of patients underwent a subsequent removal of hardware procedure, and 13% of these patients experienced complications after this procedure. Our findings suggest that the use of a single incision with intervals to the TMTJ is a viable way of approaching and visualizing the medial Lisfranc injury, while minimizing soft tissue compromise.…”

“…Anatomic reduction can best be achieved via an open approach but may incur wound dehiscence, skin necrosis, soft tissue infection, neuroma formation, and development of complex regional pain syndrome (CRPS). 7,9,13,19,22,25,[31][32][33] Traditionally, the approach to the midfoot has involved multiple longitudinal incisions over the dorsum of the foot separated by skin bridges. 2,19 However, the risks of this approach include poor visualization of the transversely oriented TMTJ, as well as the potential for skin necrosis between the narrow skin bridges.…”

“…Anatomic reduction can best be achieved via an open approach but may incur wound dehiscence, skin necrosis, soft tissue infection, neuroma formation, and development of complex regional pain syndrome (CRPS). 7,9,13,19,22,25,31-33…”

Evaluation of computed tomography post-processing images in postoperative assessment of Lisfranc injuries compared with plain radiographs

“…The software then cuts slices through the volume in a different plane. In the MPR mode, additional details of the internal structure of bones and the joint space could be figure out [ 23 , 24 ]. The VR technique images tissue by measuring the transparency of different tissues.…”