Journal List > J Korean Foot Ankle Soc > v.18(3) > 1043303

Park and Yi: Analysis of Clinical Outcome and Prognosis for Lisfranc Joint Fracture and Dislocation according to the Injury Mechanism and Treatment Method

Abstract

Purpose:

The purpose of this study was to assess the treatment outcomes and prognosis of Lisfranc joint fracture and dislocation according to the mechanism of injury and treatment method.

Materials and Methods:

Twenty six patients with Lisfranc fracture-dislocation who had been treated surgically were included in this retrospective study. The patients were divided into two groups according to mechanism of injury: direct crushing injury (16 patients) and indirect rotational or compressive injury (10 patients). The patients were also divided into three groups according to the surgical methods. The parameters used were radiographic evaluation, patients’ subjective satisfaction levels, length of hospital stay, and the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score. Statistical analysis was performed.

Results:

The mean postoperative AOFAS midfoot score was 78.7. The mean length of stay was 39.6 days. Statistically significant differences in subjective satisfaction, AOFAS midfoot score, and length of hospital stay were observed between the two groups (p<0.05). However, no significance differences were observed between the three groups who were divided according to the different surgical methods (p>0.05).

Conclusion:

Mechanism of trauma and the severity of soft-tissue injury were significant prognostic factors affecting the surgical outcomes of Lisfranc joint fracture and dislocation.

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Figure 1.
(A) Preoperative anteroposterior radiograph of left foot showed fracture and dislocation of Lisfranc joint. (B) Postoperative anteroposterior radiograph of left foot showed well reduced fracture and dislocation with cannulated screw fixation.
jkfas-18-124f1.tif
Figure 2.
(A) Preoperative anteroposterior radiograph of left foot showed fracture and dislocation of Lisfranc joint. (B) Postoperative anteroposterior radiograph of left foot showed well reduced fracture and dislocation of Lisfranc joint using percutaneous K-wire fixation.
jkfas-18-124f2.tif
Figure 3.
(A) Preoperative anteroposterior radiograph of right foot showed fracture and dislocation of Lisfranc joint. (B) Preoperative lateral radiograph of right foot showed fracture and dislocation of Lisfranc joint. (C) Postoperative anteroposterior radiograph of right foot showed well reduced fracture and dislocation of Lisfranc joint using Ilizarov external fixator. (D) Postoperative lateral radiograph of right foot showed well reduced fracture and dislocation of Lisfranc joint using Ilizarov external fixator.
jkfas-18-124f3.tif
Table 1.
Summary of Cases
Case no. Trauma mechanism Sex Age (yr) Operation method Myerson classification
1 Direct Male 32 OR A (lateral)
2 Indirect Male 25 OR B2
3 Indirect Male 46 CR B2
4 Indirect Male 32 CR B2
5 Indirect Male 33 OR C1
6 Direct Male 28 CR B1
7 Direct Female 16 OR C1
8 Direct Female 68 OR C2
9 Direct Male 34 OR B2
10 Direct Male 22 OR B2
11 Direct Male 34 OR C1
12 Direct Male 15 OR B1
13 Direct Male 45 CR C1
14 Direct Male 22 CREF A (dorsoplantar)
15 Indirect Male 49 OR C2
16 Direct Male 64 CREF A (lateral)
17 Direct Male 28 CREF B1
18 Direct Male 50 OR B2
19 Indirect Female 24 OR B1
20 Direct Male 75 OR B1
21 Indirect Female 56 OR B1
22 Direct Male 49 CREF B2
23 Indirect Male 31 CR A (lateral)
24 Indirect Male 43 OR 44
25 Indirect Male 65 OR A (lateral)
26 Direct Female 82 CR B2

OR: open reduction and internal fixation, CR: closed reduction and percutaneous pinning, CREF: closed reduction and external fixation.

Table 2.
Reduction Accuracy and Clinical Outcomes of All Patients
Case no. Reduction accuracy AOFAS midfoot score LOM Subjective satisfaction LOS
1 Anatomical 81 + 4 16
2 Anatomical 82 4 18
3 Anatomical 87 5 11
4 Anatomical 92 5 23
5 Anatomical 90 5 19
6 Anatomical 72 + 3 33
7 Satisfactory 68 + 2 63
8 Unsatisfactory 65 + 2 127
9 Satisfactory 72 + 3 41
10 Anatomical 81 + 4 114
11 Anatomical 81 4 8
12 Anatomical 64 2 84
13 Anatomical 82 4 24
14 Anatomical 93 5 79
15 Unsatisfactory 51 + 2 28
16 Anatomical 82 + 4 18
17 Satisfactory 92 + 5 24
18 Satisfactory 75 3 87
19 Anatomical 92 5 7
20 Satisfactory 79 3 79
21 Anatomical 92 5 15
22 Anatomical 72 + 3 23
23 Satisfactory 89 5 6
24 Anatomical 82 5 21
25 Satisfactory 82 5 17
26 Unsatisfactory 48 2 45

AOFAS: American Orthopaedic Foot and Ankle Society, LOM: limitation of motion, LOS: length of hospital stay.

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