A Novel Approach To Treating Lisfranc Fractures
Given the potential for debilitating complications with Lisfranc fractures, the authors discuss the advantages of closed reduction with percutaneous screw fixation and offer a step-by-step guide to the procedure.
Acute fracture/dislocations of the tarsometatarsal (Lisfranc) joint in the sensate patient continue to be challenging injuries to treat given the potential for the development of painful arthritis and chronic disability. Current day Lisfranc fracture/dislocation injuries represent approximately 0.2 percent of all fractures reported.1 Males are 2 to 10 times more likely to sustain Lisfranc injuries in comparison to females and most injuries occur in the fourth decade of life.1
The potential for disability increases if treatment is not expedited. Researchers have reported that a delay in diagnosis of fracture/dislocations of the Lisfranc joint occurs up to 20 percent of the time.2 Surgical management of Lisfranc injuries is uniquely challenging and warrants further discussion of available operative techniques.
One of the most important considerations in surgical management of Lisfranc injuries is anatomic reduction of the Lisfranc joint complex followed by rigid stabilization until osteoligamentous healing occurs. Several treatment options exist for the treatment of Lisfranc fracture/dislocations. Unfortunately, the current and most acceptable classification system for evaluating these injuries does not give insight into the choice of surgical procedure and is not predictive of outcome after treatment.3 Regardless of the chosen surgical technique, an accurate anatomic reduction is consistently associated with improved functional outcomes.4,5
Conservative treatment options exist and include casting with and without closed reduction of the unstable joints. Research has proven this to be ineffective.6-8 Open reduction internal fixation (ORIF) with primary arthrodesis is certainly indicated with greater articular damage or for primarily ligamentous injuries. Although ORIF with primary arthrodesis is represented in the literature as a surgical option and is currently in vogue, it occurs infrequently.9 Secondary arthrodesis also remains an option after the failure of other treatment options. Percutaneous wire fixation with casting has proven suitable but is not ideal.10
What A Systematic Literature Review On Percutaneous Screw Fixation Reveals
Closed reduction with percutaneous screw fixation can be an effective surgical technique to deliver internal fixation and maintain closed reduction. To our knowledge, the literature has not commonly described closed reduction with percutaneous fixation. This prompted further investigation in the form of a systematic review, which addressed the efficacy of percutaneously delivered internal screw fixation following closed anatomic reduction of acute traumatic Lisfranc fracture/dislocations.
In September 2010, we conducted a systematic review of electronic databases and relevant peer-reviewed sources including Infotrieve-Pubmed/Medline (www4. infotrieve.com/newmedline/search.asp). We then searched each identified manuscript for pertinent references. For this review, we only included manuscripts that involved closed anatomic reduction of acute traumatic Lisfranc fracture/dislocations and percutaneous delivery of internal screw fixation. Additionally, the injury had to involve a closed soft tissue envelope and a minimum mean follow-up of three years to determine postoperative sequela.