Salvage of Lisfranc's Tarsometatarsal Joint by Arthrodesis

Abstract

Sixteen patients with fractures or fracture-dislocations of the tarsometatarsal (Lisfranc) joint who failed initial treatment were salvaged by arthrodesis using a technique of rigid internal fixation. Preoperative symptoms included local pain in all patients, progressive flatfoot deformity with forefoot abduction in 12 patients, and ankle or lateral impingement pain in five. The technique involved exposing the joint, denuding it of cartilage and scar, and reduction and fixation with lag screws. A total of 49 joints were fused. When significant deformity was present, reduction was performed before arthrodesis. Clinically symptomatic and radiographically proven nonunion occurred in four sites in three patients. One healed after revision. Good to excellent results were obtained in 11 patients (69%). Five patients had a fair or poor results. All but one of the patients were subjectively improved. Four patients were symptom free and returned to their preinjury lifestyles. Accurate reduction and early treatment had a significant positive relationship with outcome. Injuries that occurred in the workplace and those that incurred a long delay until treatment showed a significant negative correlation to outcome. Neither the age of the patient nor the number of joints fused had a significant impact on result.

Lisfranc injuries

“…Unstable injuries that are misdiagnosed or inadequately treated generally go on to a poor result with persistent pain, activity limitations, and progressive post-traumatic arthritis in the involved joints [1,5], generally necessitating arthrodesis as salvage [6,7]. Chronic Lisfranc injuries (treated late) have historically been associated with less optimal outcomes relative to those properly diagnosed and treated at the time of injury, likely because of the effects of malalignment and abnormal load distribution across the involved joints prior to treatment.…”

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

“…If conservative measures fail to relieve the symptoms of these changes, arthrodesis of the painful tarsometatarsal joints is the treatment of choice [13, Fig. 3 Myerson et al classification of Lisfranc fracture-dislocations 16,36]. In our review, post-injury arthrodesis for posttraumatic arthritis was reported in 15 (7.8%) out of 192 patients (74.7%) during the last follow-up in five papers [11,17,21,23,33].…”

Screw and Wire Fixation for Lisfranc Fracture Dislocations

“…Treatment ranges from closed reduction with or without Kirschner wire fixation 17,24,25 to anatomic reduction and internal fixation with Kirschner wires and/or screws. [26][27][28][29][30] Such injuries are frequently missed or misdiagnosed, 18,31,32 as the plantar ecchymosis sign 33 (associated with toe dislocation) and the fleck sign at the base of the second metatarsal 22 are not well known. Road traffic accidents are commonest cause of fracture dislocations, whereas twisting usually causes dislocations without fractures.…”