Functional Outcome Following Anatomic Restoration of Tarsal-Metatarsal Fracture Dislocation

Abstract

Anatomic restoration of displaced fracture-dislocation of the tarsometatarsal junction of the foot is essential, as even "minor" disruptions of this joint complex leads to poor clinical results. In order to determine a "key" element associated with good or poor functional outcomes, 11 patients with excellent radiographic results following surgical treatment of unilateral closed Lisfranc fracture-dislocation of the tarsometatarsal joint of the foot were evaluated at an average of 41.2 (range, 14 to 53) months following their injury and surgery. Their average age was 40.6 (range, 21 to 58) years. AOFAS midfoot scores averaged 71.0 (range, 30 to 95). Radiographic analysis at follow-up revealed anatomic reduction in 10 of 11. Eight of 11 had evidence of arthritis of the tarsometatarsal joints. Clinical alignment was normal in all subjects, with nine of 11 clinically exhibiting decreased relative range of motion. Gait analysis was performed with the F-Scan (Tekscan, Boston, MA) in-shoe pressure-monitoring system. Vertical ground reaction force was recorded under the hallux, first metatarsal head, lateral metatarsals, and heel. Stance phase duration, rate of loading, rate of unloading, peak loading, and total loading were recorded at each of the named regions. There was no statistical difference in the parameters measured between the injured and normal control feet. The results of this study reveal that when anatomic reduction is accomplished in tarsometatarsal fracture dislocation of the foot, objective measures of gait analysis are returned to normal. In spite of excellent radiographic results and return to normal dynamic walking patterns, subjective patient outcomes were less than satisfactory. It is presently well accepted that fracture-dislocations of the tarsometatarsal junction of the foot are best treated with anatomic restoration by closed, percutaneous or open methods. Many individuals achieve poor functional results. It is well accepted that patients are likely to develop late joint deformity at the tarsometatarsal junction, joint separation, and radiographic and clinical evidence of post-traumatic arthritis when anatomic reduction is not obtained. (1-7) The goal of this study was to determine if clinical results and subjective patient outcomes are assured with anatomic reduction. It appears that the major function of the tarsometatarsal joint complex is the regulation and redirecting of loading forces during weightbearing. There is very limited motion of the tarsometatarsal joint during walking. (8) This knowledge has prompted support for anatomic restoration following injury. Even with seemingly anatomic restoration of normal alignment, many patients fare poorly. The goal of this study was to objectively analyze the components of vertical ground reaction force during walking in patients who had evidence of excellent surgical reduction measured on follow-up weightbearing radiographs following isolated injury to the tarsometatarsal joint complex. We hoped to detect some key element of gait altered by the inj...

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

“…Their diagnosis can be difficult and when missed, patients have poor reported outcomes [2]. Anatomic reduction has been shown to be the primary determining factor in achieving acceptable outcomes [27]. How to best achieve this result remains debatable [19].…”

“…This is a relatively rare injury with an incidence of approximately 0.2% of all fractures [1] although it is frequently diagnosed late and this leads to poor functional outcomes for the patient [5]. 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].…”

The role of reduction and internal fixation of Lisfranc fracture–dislocations: a systematic review of the literature

“…A total of 11 papers satisfied the inclusion criteria and received critical analysis [2,11,17,21,23,30,31,33,34,38,39]. There were seven case series retrospective studies [2,17,30,31,33,38,39], two comparative cohort studies [23,34], and two prospective randomised control trials-comparative studies [11,21]. From the latter four studies only the data from the groups of patients who were treated by internal fixation were included in the review.…”

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

“…Gaweda [11] reported, in his series of 41 patients with acute and chronic Lisfranc injuries followed for 16 years, that the best results were achieved after closed reduction and percutaneous K-wire fixation in acute cases. Teng et al [12] analyzed the gait of the injured foot and the control foot in cases of Lisfranc injury with anatomic reduction, and showed no significant difference in the parameters. Therefore, anatomic reduction of the Lisfranc injury is essential to restore normal function of the foot.…”