Comparing the outcomes between Chopart, Lisfranc and multiple metatarsal shaft fractures

Kösters, C.; Bockholt, S.; Müller, C.; Winter, C.; Rosenbaum, D.; Raschke, M. J.; Ochman, S.

Affiliations

¹Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, University of Muenster, Albert Schweitzer Campus 1, Building W1, 48149, Muenster, Germany

²Motion Analysis Laboratory, Institute for Experimental Musculoskeletal Medicine (IEMM), University Hospital, University of Muenster, Albert Schweitzer Campus 1, D3, 48149, Muenster, Germany

Abstract and keywords

Objectives: Complex midfoot injuries could lead to severe functional impairment of mobility and quality of daily living. Aim of this study was to compare the clinical and functional outcomes of Chopart, Lisfranc fractures and multiple metatarsal shaft fractures.

Design: Retrospective case series.

Setting: Level one trauma center.

Intervention: Open or closed reduction and internal fixation with screws, K-wires, plates, external fixation or combination of different technics.

Main outcome measurements: The American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score and the Maryland Foot Score were used to assess pain and functional outcome. 3D gait analysis, pedobarographic analysis and radiologic examinations were performed. The activity level was measured by a step counting accelerometer. All results were compared to an age-matched healthy control group.

Results: 24 patients with a median age of 44 years (16–72) were included: 12 patients with multiple metatarsal shaft fractures, 6 patients with Chopart and 6 patients with Lisfranc fractures. The median follow-up was 2.6 years. The pedobarographic analysis reports reduced contact time of the total foot (p = 0.08), the forefoot (p = 0.008) and the hallux (p = 0.015) for the injured foot. A median score of 64 for the SF-36, 64 for the AOFAS Midfoot Score and 73 for the Maryland Foot Score indicated a poor restoration of foot function. Multiple metatarsal shaft fractures presented a significantly lower walking speed (p = 0.03) and cadence (p = 0.04).

Conclusion: The worst results were reported for multiple metatarsal shaft fractures on outcome scores, pedobarography, gait analysis and activity. Metatarsal serial fractures should not be underestimated as well as Chopart and Lisfranc fractures.

Level of evidence: Level IV.

Keywords: Multiple metatarsal fractures; Gait analysis; Pedobarography; Chopart; Lisfranc;Step counter

Links

DOI: 10.1007/s00402-014-2059-8

PubMed: 25064509

WoS: 000342423400007

History

Received: 2014-03-29

Online: 2014-07-27

Cited Works (11)

Year	Entry
1998	Burroughs KE, Reimer CD, Fields KB. Lisfranc injury of the foot: a commonly missed diagnosis. Am Fam Physician. 1998;58(1):118-124.
2006	Desmond EA, Chou LB. Current concepts review: Lisfranc injuries. Foot Ankle Int. 2006;27(8):653-660.
2010	Schepers T, Kieboom B, van Diggele P, Patka P, Van Lieshout EMM. Pedobarographic analysis and quality of life after Lisfranc fracture. Foot Ankle Int. 2010;31(10):857-864.
2002	Richter M, Thermann H, Huefner T, Schmidt U, Kretter C. Aetiology, treatment and outcome in Lisfranc joint dislocations and fracture dislocations. Foot Ankle Surg. 2002;8(1):21-32.
2002	Richter M, Wippermann B, Thermann H, Schroeder G, Otte D, Troeger HD, Krettek C. Plantar impact causing midfoot fractures result in higher forces in Chopart's joint than in the ankle joint. J Orthop Res. 2002;20(2):222-232.
2001	Richter M, Wippermann B, Krettek C, Schratt HE, Hufner T, Thermann H. Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results. Foot Ankle Int. 2001;22(5):392-398.
1994	Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. July 1994;15(7):349-353.
2001	Richter M, Thermann H, Wippermann B, Otte D, Schratt H-E, Tscherne H. Foot fractures in restrained front seat car occupants: a long-term study over twenty-three years. J Orthop Trauma. May 2001;15(4):287-293.
2002	Teng AL, Pinzur MS, Lomasney L, Mahoney L, Harvey R. Functional outcome following anatomic restoration of tarsal-metatarsal fracture dislocation. Foot Ankle Int. 2002;23(10):922-926.
2007	Sherief TI, Mucci B, Greiss M. Lisfranc injury: how frequently does it get missed? and how can we improve? Injury. 2007;38(7):856-860.
2000	Kuo RS, Tejwani NC, DiGiovanni CW, Holt SK, Benirschke SK, Hansen ST Jr, Sangeorzan BJ. Outcome after open reduction and internal fixation of Lisfranc joint injuries. J Bone Joint Surg. November 2000;82A(11):1609-1618.