Patients with limbs at high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to those of amputation.

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.

Assessment of pelvic fractures in severely traumatized, clinically unstable patients presents a diagnostic problem. Traditional plain-radiographic classifications of the fracture are of limited preoperative value to the surgeon who must apply corrective force in opposition to the original force vector causing the fracture. Computed tomographic scanning is an effective method of examining the pelvis but is time consuming and may be impractical in cases of severe injury. In a retrospective analysis of the plain radiographs of 142 cases of pelvic fracture, four patterns of force were identified, presenting distinctive, recognizable radiographic appearances. These patterns are anteroposterior compression, lateral compression, vertical shear, and a complex pattern. The resulting classification of pelvic fracture, based on radiographic and clinical findings, correlates with associated injury to soft-tissue structures and enables the surgeon to begin corrective procedures rapidly.

Although almost all persons living with trauma-related amputations use prosthetic devices, the majority are not satisfied with prosthetic comfort. Phantom pain and residual limb skin problems are also common afflictions in this population.