Tarso-metatarsal fracture-dislocation: treatment by percutaneous pinning or open reduction (a report on 17 cases)

摘要

Lisfranc fracture-dislocation is rare. The authors report a retrospective series of 17 cases managed by a single surgeon between 1990 and 1998. The series comprised 12 male (71%) and five female patients, aged between 11 and 62 years (mean age = 33.4 years). Etiology was predominantly road accidents (64%). On Lerat classification, 12 lesions were homolateral and five divergent. Seventy eight percent of the patients had other associated lesions and 53% were polytraumatised. Fourteen patients were treated by pinning: percutaneous in six cases and open in eight; the other three patients were seen at a late stage and underwent Lisfranc joint realignment arthrodesis. One patient died from severe cranial trauma; 12 were followed up for between 1 and 7 years (mean follow-up = 4.5 years).The eight patients managed by open or closed K-wire fixation and who were followed up had a mean midfoot Kitaoka score of 78/100: five results were good or excellent, two fair and one poor. Only 40% of the X-ray checks were strictly normal, the others disclosing joint alterations. The three cases managed by realignment arthrodesis showed union at 4 months' follow-up, with a mean Kitaoka score of 88.3/100 (2 excellent and one fair result).