Lisfranc fracture-dislocation:​ screw vs. K-wire fixation

Sánchez-Gómez, P.; Lajara-Marco, F.; Salinas-Gilabert, J. E.; Lozano-Requena, J. A.

Affiliations

¹Department of Orthopedic and Trauma Surgery. Vega baja Hospital. Orihuela. Alicante

Abstract and keywords (English)

Introduction. Fracture-dislocations of the tarso-metatarsal joint are a relatively rare injury, but their long-term consequences can be devastating for the patient. The aim of this study is to analyze the results obtained by surgical treatment.

Materials and methods. The authors reviewed 26 patients between 1995 and 2006. Fractures were classified according to the Myerson & Hardcastle classification. All patients were treated by emergency surgery by means of either screws or K-wires. The AOFAS functional scale was used to assess results in the midfoot; patient satisfaction was also evaluated.

Results. After a mean 5-year follow-up, the mean score on the AOFAS scale was 85.38 points, with a high level of satisfaction in nearly all patients. Results obtained with screw fixation were slightly better than those with K-wires.

Conclusions. Like most authors, we believe that the best results are to be obtained by the immediate reduction and fixation of the injury. We rule out nonoperative treatment and favor an ORIF procedure with screws provided that the condition of the soft tissues allows it.

Keywords: foot; Lisfranc joint; fracture-dislocation

Abstract and keywords (Spanish)

Introducción: La fractura-luxación de la articulación tarsometatarsiana es una lesión relativamente infrecuente, pero cuyas consecuencias a largo plazo pueden ser devastadoras para el paciente. El objetivo de este estudio fue analizar los resultados del tratamiento quirúrgico.

Material y método: Los autores presentan una revisión de 26 pacientes tratados entre los años 1995 y 2006. Las fracturas fueron clasificadas según Myerson y Hardcastle. Todos los pacientes fueron tratados quirúrgicamente de urgencia usando tornillos o agujas de Kirschner. Para la valoración de resultados se utilizó la escala de valoración funcional de la AOFAS para el mediopié, analizando también el grado de satisfacción subjetiva de los pacientes.

Resultados: Tras un seguimiento medio de 5 años, la puntuación media en la escala AOFAS fue de 85,38 puntos, siendo el grado de satisfacción alto en casi todos los pacientes. Los resultados conseguidos en la osteosíntesis con tornillos fueron ligeramente superiores a los obtenidos con agujas de Kirschner.

Conclusiones: Como la mayoría de autores, recomendamos la urgente reducción y síntesis de la lesión para conseguir los mejores resultados, descartando como opción el tratamiento ortopédico e inclinándonos por una reducción abierta y fijación interna con tornillos, siempre que el estado de las partes blandas lo permita.

Keywords: pie, articulación de Lisfranc, fractura-luxación.

Links

DOI: 10.1016/S1988-8856(08)70084-1

History

Received: 2006-05

Accepted: 2007-03

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Cited By (3)

Year	Entry
2014	Yu X, Pang Q-J, Yang C-C. Functional outcome of tarsometatarsal joint fracture dislocation managed according to Myerson classification. Pak J Med Sci. July–August 2014;30(4):773-777.
2012	Lievers WB, Frimenko RE, Crandall JR, Kent RW, Park JS. Age, sex, causal and injury patterns in tarsometatarsal dislocations: a literature review of over 2000 cases. Foot. September 2012;22(3):117-124.
2013	Schepers T, Oprel PP, Van Lieshout EMM. Influence of approach and implant on reduction accuracy and stability in Lisfranc fracture-dislocation at the tarsometatarsal joint. Foot Ankle Int. May 2013;34(5):705-710.