Diagnosis and treatment of old Lisfranc joint injury

Abstract

Objective To discuss causes and treatment of old fracture dislocation of tarsometatarsal joints. Methods From August 2004 to June 2008, 20 cases (16 males and 4 females, 21 to 49 years old) of old Lisfranc injure were treated. According to Myerson classification, 3 cases were type Ⅰ, 13 cases type Ⅱ, and 4 cases type Ⅲ. X-ray emanation and three dimensional CT reconstruction were conducted. Open reduction and fixation using K-wires and screws were adopted for 17 cases and tarsometatarsal joints fusion for 3 cases. Results Postoperatively only 18 cases were followed up for 6 months to 4 years. According to Maryland scoring system, 3 cases were rated as excellent, 12 good, and 3 moderate. Although no breaking of internal fixator or refracture-dislocation was found, midfoot pain and limited walking function existed in some cases. Conclusions Lisfranc injuries are sometimes easily missed because of poor radiographic repre-sentations, or incorrect methods in primary diagnosis and treatment. For most old Lisfranc injury cases, open reduction and internal fixation of tarsometatarsal fracture-dislocations leads to improved functional results. And corrective arthrodesis can also release pain and lead to greater patient satisfaction. Anatomic reduction and stable fixation, especially anatomic restoration of the foot arch, are key points in the treatment of old Lisfranc injury. Key words: Foot injuries; Foot joints; Therapy