Acta Ortopédica Mexicana

García-Renedo RJ, Carranza-Bencano A, Busta-Vallina B, Ortiz-Segura J, Plaza-García S, Gómez-del Álamo G
Long-term results of the treatment of Lisfranc fracture dislocation
Acta Ortop Mex 2012; 26 (4)

Language: Español
References: 34
Page: 235-244
PDF: 142.40 Kb.

[Fulltext - PDF]

ABSTRACT

We conducted an ambispective cohort study of 83 patients with a diagnosis of Lisfranc fracture dislocation from 1993 to 2008. The lesions were classified into two groups: pure dislocations and fracture dislocations of the Lisfranc joint using the Hardcastle-Reschamer classification. The results included the following data: sociodemographic and epidemiologic variables, lesion-related variables, clinical parameters, and the following clinical and functional assessment scales: Baltimore Painful Foot Score, Creighton-Nebraska Health Foundation, American Orthopaedic Foot and Ankle Society (AOFAS), and Hannover Scoring System. Sixty-three patients were treated surgically. Closed reduction and minimally invasive fixation with Kirschner nails were performed in 53 patients (63.9%), and open reduction with a dorsal approach and fixation with Kirschner nails in 10 cases (15.2%). In 46 cases de medial column was fixed, in 61 cases the intermediate column, and in 42 the lateral column. Sixty-six (79.5%) of the patients had complications including both acute and late ones. Regardless of the technique used, the purpose of treatment was the anatomical reduction of the involved joints. Based on our experience, we think that the use of Kirschner nails is effective, as it provides enough stiffness and stability. In general terms, this injury is not as disabling as it had been considered in the literature. Patients consider their discomfort as tolerable and compatible with the demands of their activities of daily living and they may perform their work considering the time limitations.


Key words: ankle, ankle injuries, fracture, dislocation, mobility limitations, disability, evaluation, stabilization, fixation.


REFERENCES

  1. Cain PR, Seligson D: Lisfranc´s fracture-dislocation with intercuneiform dislocation: Presentation of two cases and a plan for treatment. Foot Ankle 1981; 2: 156.

  2. Rosemberg GA, Patterson BM: Tarsometatarsal (Lisfranc´s) fracture-dislocations. Am J Orthop 1995; 1: 7-16.

  3. Teng AL, Pinzus MS, Lomasney L, Havey R: Functional outcome following anatomic restoration of tarsal-metatarsal fracture dislocations. Foot Ankle Int 2002; 23(10): 922-6.

  4. O´Connor PA, Yeap S, Noel J, Khayyat G, Kennedy JG, Arividian S, McGuinness AJ: Lisfranc injuries: patient and physician based functional outcomes. Int Orthop 2002; 27(2): 98-102.

  5. Richter M, Wippermann B, Krettek C, Scharatt HE, Hufner T: Fractures and fracture dislocations of the midfoot; occurrence, causes and long terms results. Foot Ankle Int May 2001; 22(5): 392-8.

  6. Buzzard BM, Briggs PJ: Surgical management of acute tarsometatarsal fracture dislocation in the adult. Clin Orthop 1998; (353): 125-33.

  7. Grandberry WM, Lipscomb PR: Dislocations of the tarsometatarsal joints. Surg Gynecol Obstet 1962; 114: 467-9.

  8. Compere EL, Banks SW: Pictorial Handbook of fracture treatment. 5th ed. Chicago: Year Book Publishers; 1943.

  9. Myerson MS, Fisher RT, Burgess AR: Fracture-dislocation of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot and Ankle 1986; 6: 225-42.

  10. Harcartle PH, Reschauer R, Kutscha-Lissberg E: Injuries to the tarsometatarsal joint: Incidence, classification and treatment. J Bone Joint Surg (Br) 1982; 64: 349-56.

  11. Quenu E, Kuss G: Etude sur les luxations du metatarse (luxations metatarso-tarsiennes) du diastasis entre le 1er et 2e metatarsien. Revue de Chirurgie 39; 1909: 281-336, 720-91, 1093-134.

  12. Franciszewski T, Burks RT, Manaster BJ: Subtle injuries of the Lisfranc Joint. J Bone Joint Surg 1990: 72: 1519-22.

  13. Curtis MJ, Myerson M, Suruza B: Tarsometatarsal joint injuries in the athlete. Am J Sports Med 1993; 21: 497-501.

  14. Engber WD, Roberts JM: Irreductible tarsometatarsal fracture dislocations. Clin Orthop 1982; 168: 102-4.

  15. Wilson DW: Injuries of the tarsometatarsal joints: Etiology, classification and results of treatment. J Bone Joint Surg 1972; 54B: 677.

  16. Buzzard BM, Briggs PJ: Surgical management of acute tarsometatarsal fracture dislocation in the adult. Clin Orthop 1998; (353): 125-33.

  17. Lisanti L, Rosati M, Nesti C, Cantini G, Rosetti C: Our results in the treatment of fractures dislocations of Lisfranc´s joint. Chir Organi Mov 2001; 86(4): 281-91.

  18. Rajapakse B, Edwards A, Hong T: A single surgeon´s experience of treatment of Lisfranc joint injuries. Injury 2006; 37: 914-21.

  19. Aitken AP, Poulson D: Dislocations of the tarsometatarsal joint. J Bone Surg (Am) 1963; 45: 246-60.

  20. Preidler KW, Wang Y, Brossmann J, Trudell D, Daenen B, Resnick D: Tarsometatarsal joint: anatomic details on MR images. Radiology 1996; 199: 733-6.

  21. Arntz CT, Hansen ST: Dislocations and fracture dislocations of the metatarsal joints. Orthop Clin North Am 1987; 18: 105-14.

  22. Wilson DW: Injuries of the tarsometatarsal joints: Etiology, classification and results of treatment. J Bone Joint Surg 1972; 54B: 677.

  23. Preidler KW, Wang Y, Brossmann J, Trudell D, Daenen B, Resnick D: Tarsometatarsal joint: anatomic details on MR images. Radiology 1996; 199: 733-6.

  24. Villanueva E, Alcántara P, Juan Llabrés A: Fracturas-luxaciones tarso-metatarsianas. Rev Orthop Traum 1993; 37IB (3): 209-14.

  25. Owens BD, Wixted JJ, Cook J: Intramedullary transmetatarsal Kirschnner wire fixation of Lisfranc fracture dislocations. Am J Orthop 2003; 32(8): 389-91.

  26. Arntz CT, Veith RG, Hansen STJ: Fractures and fracture dislocations of tarsometatarsal joint. J Bone Joint Surg Am 1998; 70A: 173-81.

  27. Vuori JP, Aro HT: Lisfranc joint injuries: trauma mechanisms and associated injuries. J Trauma 1993; 35: 40-5.

  28. Licht N, Trevino S: Lisfranc injuries. Techniques in Orthopaedics 1991; 6: 77-83.

  29. Sangeorzan BJ, Veith RG, Hansen ST: Salvage of Lisfranc´s tarsometatarsal joint by arthrodesis. Foot Ankle 1990; 10: 192-200.

  30. Kuo RS, Telwani NC, DiGiovanni CW: Outcome after open reduction and internal fixation of Lisfranc joint injuries. J Bone Joint Surg (Am) 2000; 82-A: 1609-18.

  31. Richter M, Wippermann B, Krettek C, Scharatt HE, Hufner T: Fractures and fracture dislocations of the midfoot; occurrence, causes and long terms results. Foot Ankle Int May 2001; 22(5): 392-8.

  32. Yuen JS, Yung SW, Wong MK: Open reduction and temporary rigid internal fixation of Lisfranc fracture-dislocations. Singapore Med J 2001; 42(6): 255-8.

  33. Blanco RP, Merchan CR, Sevillano RC, Martinez LM: Tarsometatarsal fractures and dislocations. J Orthop Trauma 1988; 2: 188-94.

  34. Geckeler EO. Dislocations and fracture-dislocation of the foot: Traxfixion with Kirschner wires. Surgery1949; 25: 730-3.