Study of the functional results of the percutaneous surgical treatment of subtle injuries of the tarso-metatarsian complex

Abstract

Introduction and objectivesThe concept "subtle Lisfranc" defines low energy lesions of the tarsometatarsal joint complex (TMC) that involve joint instability. Often unnoticed, with long-term sequelae.The objective is to evaluate the clinical-functional results of patients with MTC ligament damage grade II-III (Nunley and Vertullo classification) treated with percutaneous surgery. Material and methodsRetrospective study of 16 patients who underwent percutaneous surgery for MLC ligament damage. Demographic data, days of delay in diagnosis, surgical technique, joint reduction in load (adequate if C1-M2 space is less than 2 mm) and Manchester-Oxford scale (MOXFQ) score were collected. The sample consisted of 9 males and 7 females, mean age 43.6 years (17–71) and mean follow-up of 22 months (12–28). ResultsDiagnosis was delayed for more than 24 h in 4 patients (3–6 days). In 11 patients the treatment consisted of closed reduction and percutaneous synthesis with cannulated screws from M2 to C1 and from C1 to C2. In 3 patients it was supplemented with Kirschner wires in the lateral radii. 2 patients were treated with only M2 to C1 screws. An anatomical reduction was not achieved in 6 patients, with a mean of 2.6 mm between C1-M2 (2.1−3 mm); the mean functional MOXFQ score of these patients was 41.1% (IC95% 23.1%–59.1%), worse results compared to the anatomical reduction: 17.2% (IC95% 5.7–28.7); statistically significant difference (p < 0.01). ConclusionSubtle injuries from MTC are rare and can go unnoticed. Surgical treatment with percutaneous synthesis offers good clinical-functional results in the medium term. The anatomical reduction is a determining factor for the good functional result of our patients.