Abstract
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.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: May 17, 2014
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
