Lisfranc fracture-dislocation can be a devastating injury with significant long-term sequelae, including degenerative joint disease, progressive arch collapse, and chronic pain that can be potentiated if not effectively treated. We present a case to demonstrate our preferred surgical approach, consisting of combined medial column primary arthrodesis, middle column open reduction internal fixation, and lateral column pinning, with the primary goal of minimizing common long-term complications associated with Lisfranc injuries. We present the case of a typical patient treated according to this combined surgical approach to highlight our patient selection criteria, rationale, surgical technique, and operative pearls. A 36-year-old male who had sustained a homolateral Lisfranc fracture-dislocation injury after falling from a height initially underwent fasciotomy for foot compartment syndrome. The subsequent repair 16 days later involved primary first tarsometatarsal joint fusion, open reduction internal fixation of the second and third tarsometatarsal joints, and temporary pinning of the fourth and fifth tarsometatarsal joints. He progressed well postoperatively, exhibiting an American College of Foot and Ankle Surgeons forefoot score of 90 of 100 at 1 year after surgery with no need for subsequent treatment. Lisfranc fracture-dislocations often exhibit primary dislocation to the medial column and are conducive to arthrodesis to stabilize the tarsometatarsal complex. The middle column frequently involves comminuted intra-articular fractures and will often benefit from less dissection required for open reduction internal fixation instead of primary fusion. We propose that this surgical approach is a viable alternative technique for primary treatment of Lisfranc fracture-dislocation injuries.
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- The diagnosis and treatment of injury to the tarsometatarsal joint complex.J Bone Joint Surg. 1999; 81: 756-763
- Technical considerations in tarsometatarsal joint arthrodesis.J Am Podiatr Med Assoc. 2005; 95: 85-90
- Injuries to the tarsometatarsal joint: incidence, classification and treatment.J Bone Joint Surg. 1982; 64B: 349-356
- Fractures and fracture-dislocations of the tarsometatarsal joint.J Bone Joint Surg. 1988; 70A: 173-181
- The treatment of Lisfranc injuries.Acta Orthop Belg. 1997; 9: 156-160
- Injuries to the forefoot and toes.in: Jahss M. Disorders of the Foot and Ankle: Medical and Surgical Management. ed 2. WB Saunders, Philadelphia1991: 2240-2246
- Metatarsal fractures and dislocations and Lisfranc’s fracture dislocations.in: Gould J. Operative Foot Surgery. WB Saunders, Philadelphia1994: 409-417
- Open reduction internal fixation versus primary arthrodesis for Lisfranc injuries: a prospective randomized study.Foot Ankle Int. 2009; 30: 913-922
- Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation.J Bone Joint Surg. 2006; 88: 514-520
- Experimental decompression of the fascial compartments of the foot—the basis for fasciotomy in acute compartment syndromes.Foot Ankle. 1988; 8: 308-314
- ACFAS scoring scale user guide.J Foot Ankle Surg. 2005; 44: 316-335
- Validation of the American College of Foot and Ankle Surgeons scoring scales.J Foot Ankle Surg. 2011; 50: 420-429
- Salvage of Lisfranc’s tarsometatarsal joint by arthrodesis.Foot Ankle. 1990; 10: 193-200
- Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment.Foot Ankle. 1986; 6: 225-242
- Severe Lisfranc injuries: primary arthrodesis or ORIF?.Foot Ankle Int. 2002; 23: 902-905
- Arthrodesis versus ORIF for Lisfranc fractures.Orthopedics. 2012; 35: 868-873
- Functional Reconstruction of the Foot and Ankle.JB Lippincott, Philadelphia2000
- Ischemic contracture of the foot and ankle: principles of management and prevention.Orthopedics. 1996; 19: 235-244
- Compartmental syndrome. A unified concept.Clin Orthop. 1975; 113: 8-14
- Review: acute compartment syndrome of the foot.Foot Ankle Int. 2003; 24: 180-187
Published online: May 17, 2014
Financial Disclosure: None reported.
Conflict of Interest: None reported.
© 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.