Treatment Of Complex Open Lisfranc Injury In A Professional Bull Rider

Abstract

HISTORY: An otherwise healthy 30-year-old male professional bull rider presented to our hospital as a transfer for an open left foot fracture after a bull stepped on his left foot during a professional competitive rodeo event. He immediately experienced pain in the affected foot. He denied any other injuries including trauma to the head or loss of consciousness. Although he has had multiple orthopedic injuries in the past, he denied any previous foot injuries to the left foot. PHYSICAL EXAMINATION: Physical examination revealed a large laceration on the medial aspect of the left foot over the 1st metatarsal with an open dislocation of the MT head. The open laceration site was 9 cm x 4 cm. The patient had mild loss of sensation and was unable to elicit movement in his toes. There was no trauma or tenderness present on the left hip, femur, knee or lower leg. DIFFERENTIAL DIAGNOSIS: 1. Open Lisfranc injury 2. Tarsometatarsal dislocation TEST AND RESULTS: Anterior-Posterior, lateral & oblique radiographs: 1. Complete dislocation of the first metatarsophalangeal joint 2. Lisfranc fracture/dislocation 3. Neck and base fractures of the second, third, and fourth metatarsals, base of fifth metatarsal 4. Cuboid fracture FINAL WORKING DIAGNOSIS: Open left first metatarsophalangeal dislocation and Lisfranc fracture-dislocation with multiple metatarsal fractures TREATMENT AND OUTCOMES: 1. Surgical irrigation & debridement of the wound, followed by open or closed fixation of fractures and dislocations. 2. Pin removal at 6 weeks post op and negative pressure wound therapy for 9 months postoperative. 3. Non-weight bearing for the first 8 weeks postoperative followed by progression to weight bearing as tolerated. 4. At 18 months post-operative, the patient was able to return to professional bull riding. 5. At 3.5 years from injury, there is residual pain and swelling present with development of hallux valgus. The foot/ankle is otherwise functioning appropriately and does not inhibit him from professional bull riding.