Clinical study on the surgical treatment of atypical Lisfranc joint complex injury

Abstract

Background: Lisfranc injuries have not received much attention by orthopedic doctors in the past, and there is little related research on the diagnosis and treatment of these injuries. In recent years with the rise in foot and ankle surgery, doctors are now paying more attention to this type of injury. However, there is still a high rate of missed diagnosis due to insufficient attention causing treatment delays or inadequate treatments, which eventually result in greater sequelae; including long-term pain, arthritis, foot deformity etc. In particular, for cases with a mild Lisfranc joint complex injury, the incidence of sequelae is higher.

Aim: To select an active surgical treatment for an atypical Lisfranc joint complex injury and to evaluate the clinical efficacy of the surgical treatment.

Methods: The clinical data of 18 patients, including 10 males and 8 females aged 20-64 years with Lisfranc injuries treated in our department from January 2017 to September 2019 were retrospectively analyzed. All patients were treated with an open reduction and internal fixation method using locking titanium mini-plates and hollow screws or Kirschner wires. X-ray images were taken and follow-up was performed monthly after the operation; the internal fixation was then removed 4-5 mo after the operation; and the American Orthopedic Foot and Ankle Society (AOFAS) score was used for evaluation on the last follow-up.

Results: All patients were followed up for 6-12 mo. A good/excellent AOFAS score was observed in 88.9% of patients.

Conclusion: For atypical Lisfranc joint complex injuries, active open reduction and internal fixation can be performed to enable patients to obtain a good prognosis and satisfactory functional recovery.

Keywords: Atypical Lisfranc injury; Avulsion fracture; Computed tomography; Lisfranc joint complex injury; Open reduction and internal fixation; Stress test.

Figure 1

A 30-year-old male with a right foot injury due to a heavy crush. A and B: X-ray images of the injured foot in the orthophoria and oblique positions, showing the avulsion fracture line of the metatarsal base and the displacement of the fracture; dislocation is not obvious; C: The postoperative incision; D-F: Preoperative computed tomography scans, showing multiple avulsion fracture fragments of the metatarsal base; G and H: X-ray images after operation in the orthophoria and oblique positions.

Figure 2

A 47-year-old female with sprains. A and B: X-ray images of the injured foot in the orthophoria and oblique positions, showing the avulsion fracture line of the metatarsal base and the displacement of the fracture; dislocation is not obvious; C: Lateral X-ray image under weight-bearing circumstances before surgery, showing no obvious displacement; D-G: Preoperative computed tomography scans showing multiple avulsion fracture fragments of the metatarsal base; H and I: X-ray images after operation in the orthophoria and oblique positions.

Figure 3

A 37-year-old female injured in a car accident. A and B: X-ray images of the injured foot in the orthophoria and oblique positions, showing the avulsion fracture line of the metatarsal base; displacement of the fracture and dislocation is not obvious; C-E: Preoperative computed tomography scans showing multiple avulsion fracture fragments of the metatarsal base; F: Signs of ecchymosis on the sole; G and H: X-ray images after operation in the orthophoria and oblique positions.

Figure 4

A 54-year-old female injured in a car accident. A and B: X-ray images of the injured foot in the orthophoria and oblique positions showing the avulsion fracture line of the metatarsal base and the displacement of the fracture and dislocation is not obvious; C: Signs of ecchymosis on the sole; D and E: Preoperative computed tomography scans, showing multiple avulsion fracture fragments of the metatarsal base; F and G: X-ray images after operation in the orthophoria and oblique positions; H: Incision and exploration during the operation showing tears in the dorsal joint capsule and ligament; the joint is unstable.