Distractor-assisted reduction for Lisfranc injury complicated with compressive fracture of lateral foot column

Abstract

Objective To evaluate distractor-assisted reduction for Lisfranc injury complicated with compressive fracture of lateral foot column. Methods A retrospective study was conducted of the 18 patients who had been treated surgically at Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital between May 2014 and March 2017 for Lisfranc injury complicated with compressive fracture of lateral foot column. They were 10 males and 8 females, with an average age of 38.4 years (from 25 to 65 years). The injury involved the right foot in 11 cases and the left foot in 7. Their concomitant injuries were 12 compressive cuboid fractures and 6 compressive fractures of the calcaneal anterior process. According to the Chiodo-Myerson classification, there were 13 cases of three-column injury, 3 ones of middle-lateral column injury and 2 ones of medial-lateral column injury. All the injuries were closed. After the condition of foot soft tissues permitted, open reduction assisted by a distractor and internal fixation with a mini locking plate was performed. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle scores and visual analogue scale (VAS) at the final follow-ups and complications during follow-up. Results The 18 patients were followed up for one to 4 years (average, 2 years). Their AOFAS hindfoot-ankle scores ranged from 55 to 96 points (average, 80.4 points); their VAS ranged from 0 to 6 points (average, 1.5 points). Radiographic evidence of degeneration was noted in 10 patients. Of them, 2 reported persistent pain which was cured by arthrodesis after conservative therapy failed and one presented with symptoms of injury to sural and cutaneous nerves which disappeared after oral administration of neurotrophic drugs for half a year. No such complication as skin necrosis, infection or implant failure occurred in other patients. Conclusion Open distractor-assisted reduction and internal fixation of lateral foot column with a mini locking plate, combined with bone graft if necessary, is an effective treatment for Lisfranc injury complicated with compressive fracture of lateral foot column, because it can effectively restore the alignment of lateral column and result in satisfactory therapeutic effects. Key words: Cuboid bone; Calcaneus; Foot joints; Fractures, bone; Fracture fixation, internal