Modern principles of treatment in Lisfranc midfoot dislocations

Abstract

The Lisfranc midfoot dislocations are uncommon, and the results of the treatment are often unsatisfactory. The open reduction and internal fixation of the tarso-metatarsal injuries by various technics like: Kirschner wiring transfixiation , screwing or combinations of these methods, are the recommended choice of treatment. The aim of the present study is to review the functional outcomes of 31 patients with dislocations and fracture - dislocations of the Lisfranc joint over a 10-year period, treated by different surgical methods. The average follow-up period was 44 (range 12 – 108) months. Results. The average American Orthopaedic Foot and Ankle Society (AOFAS) for midfoot score, used for results interpretation, was 72 (range 52 – 92); the highest scores were obtained by patients with screwing technics of internal fixation. Fourteen patients (45%) developed posttraumatic arthritis of the tarso-metatarsal joints. The major causes were an imperfect and nonanatomic reduction, and an instable internal fixation, especially in patients with only Kirschner wiring fixation as single technique used.
Conclusions. On the basis of our study, the principles of treatment of the Lisfranc tarso-metatarsal fracture- dislocations are: anatomical open reduction and stable internal fixation, using transfix screw fixation or a combination of wiring and screwing techniques.

Key words:

midfoot dislocations, Lisfranc joint, open reduction, internal fixation

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