CLINICAL AND RADIOGRAPHIC EVALUATION OF OPEN REDUCTION AND INTERNAL FIXATION WITH HEADLESS COMPRESSION SCREWS IN TREATMENT OF Lisfranc JOINT INJURIES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Hui , MIN Li , WANG Guanglin , LIU Lei , FANG Yue , TU Chongqi.

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China. Corresponding author: TU Chongqi, E-mail: tuchongqi@163.com;

Corresponding author：

Keywords：

Lisfranc joint injury; Headless compression screw; Internal fixation

DOI：

10.7507/1002-1892.20130262

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Objective To evaluate the clinical and radiographic outcomes of headless compression screws for Lisfranc joint injuries. Methods A retrospective analysis was made on clinical data of 34 patients (36 feet) with Lisfranc joint injuries who underwent open reduction and internal fixation with headless compression screws between January 2006 and January 2012. There were 22 males (24 feet) and 12 females (12 feet), aged 21-73 years (mean, 38.9 years). The causes of injury included traffic accident in 16 cases (17 feet), falling from height in 11 cases (12 feet), crushing in 5 cases (5 feet), and sports in 2 cases (2 feet). Of them, there were 19 cases (20 feet) of closed injury and 15 cases (16 feet) of open injury; there were 7 cases (8 feet) of pure dislocations of tarsometatarsal joints and ligamentous Lisfranc injuries (LD), 22 cases (23 feet) of Lisfranc joint fracture dislocations (LFD), 5 cases (5 feet) of combined Chopart-LFD (CLFD). According to Myerson classification, 5 cases (5 feet) were rated as type A, 7 cases (8 feet) as type B1, 14 cases (15 feet) as type B2, 5 cases (5 feet) as type C1, and 3 cases (3 feet) as type C2. Associated fractures included 12 cases (13 feet) of metatarsal shaft fracture, 4 cases (4 feet) of cuboid fracture, 4 cases (4 feet) of navicular bone fracture, 6 cases (7 feet) of coneiform bone fracture/dislocation, 8 cases (10 feet) of ipsilateral lower limb multiple fracture, and 4 cases (4 feet) of contralateral lower limb multiple fracture. The clinical outcomes were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score. Postoperative X-ray films were taken to assess the reduction, internal fixation, and the foot arch height. Results All patients were followed up 1 year to 5 years and 2 months (mean, 3.5 years). X-ray films showed anatomical reduction in 31 cases (33 feet, 91.7%). At last follow-up, AOFAS score and VAS score averaged 80.6 (range, 60-100) and 2.3 (range, 0-6), respectively; the AOFAS score was significantly higher in patients having anatomical reduction than the patients having no anatomical reduction, in patients with LD and LFD than in patients with CLFD, and in patients without cuneiform bone fracture/dislocation than in patients with cuneiform bone fracture/dislocation (P lt; 0.05). There was no significant difference in the talus-first metatarsal angle, the distance between the lateral edge of the base of the first metatarsal bone and the medial edge of the base of the second metatarsal bone, and the arch height between the injured foot and normal foot (P gt; 0.05). Reduction loss was observed in 1 case (1 foot) because of early weight bearing; post-traumatic arthritis developed in 9 patients (10 feet). The incidence of post-traumatic osteoarthritis was higher in the patients with non-anatomic reduction, coneiform bone fracture/dislocation, comminuted intra-articular fractures of Lisfranc joints, the injury types (P lt; 0.05). Conclusion Headless compression screws for fixation of Lisfranc joint injuries can provide satisfactory short- and mid-term clinical and radiographic outcomes. During surgery, the precise anatomic reduction and stable fixation should be paid attention to, especially in patients with CLFD, coneiform bone fracture/dislocation, and comminuted intra-articular fractures of Lisfranc joints so as to control the incidence of the post-traumatic osteoarthritis.

Citation： ZHANG Hui,MIN Li,WANG Guanglin,LIU Lei,FANG Yue,TU Chongqi.. CLINICAL AND RADIOGRAPHIC EVALUATION OF OPEN REDUCTION AND INTERNAL FIXATION WITH HEADLESS COMPRESSION SCREWS IN TREATMENT OF Lisfranc JOINT INJURIES. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(10): 1196-1201. doi: 10.7507/1002-1892.20130262 Copy

1.	Hardcastle PH, Reschauer R, Kutscha-Lissberg E, et al. Injuries to the tarsometatarsal joint. Incidence, classification and treatment. J Bone Joint Surg (Br), 1982, 64(3): 349-356.
2.	Teng AL, Pinzur MS, Lomasney L, et al. Functional outcome following anatomic restoration of tarsal-metatarsal fracture dislocation. Foot Ankle Int, 2002, 23(10): 922-926.
3.	Chiodo CP, Myerson MS. Developments and advances in the diagnosis and treatment of injuries to the tarsometatarsal joint. Orthop Clin North Am, 2001, 32(1): 11-20.
4.	Kuo RS, Tejwani NC, Digiovanni CW, et al. Outcome after open reduction and internal fixation of Lisfranc joint injuries. J Bone Joint Surg (Am), 2000, 82-A(11): 1609-1618.
5.	Pereira CJ, Espinosa EG, Miranda I, et al. Evaluation of the surgical treatment of Lisfranc joint fracture-dislocation. Acta Ortop Bras, 2008, 16: 93-97.
6.	Rammelt S, Schneiders W, Schikore H, et al. Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation. J Bone Joint Surg (Br), 2008, 90(11): 1499-1506.
7.	Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study. J Bone Joint Surg (Am), 2006, 88(3): 514-520.
8.	Richter M, Thermann H, Hüfner T, et al. Aetiology, treatment and outcome in Lisfranc joint dislocations and fracture dislocations. Foot Ankle Surg, 2002, 8(1): 21-32.
9.	Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg (Am), 1976, 58(4): 453-458.
10.	Myerson MS, Fisher RT, Burgess AR, et al. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle, 1986, 6(5): 225-242.
11.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
12.	Faciszewski T, Burks RT, Manaster BJ. Subtle injuries of the Lisfranc joint. J Bone Joint Surg (Am), 1990, 72(10): 1519-1522.
13.	Sands AK, Grose A. Lisfranc injuries. Injury, 2004, 35(Suppl 2): SB71-76.
14.	Lee CA, Birkedal JP, Dickerson EA, et al. Stabilization of Lisfranc joint injuries: a biomechanical study. Foot Ankle Int, 2004, 25(5): 365-370.
15.	Thordarson DB. Lisfranc ORIF with absorbable fixation. Techniques in Foot and Ankle Surgery, 2003, 2(1): 21-26.
16.	Borazjani BH, Chen AC, Bae WC, et al. Effect of impact on chondrocyte viability during insertion of human osteochondral grafts. J Bone Joint Surg (Am), 2006, 88(9): 1934-1943.
17.	Augustin G, Davila S, Udiljak T, et al. Determination of spatial distribution of increase in bone temperature during drilling by infrared thermography: preliminary report. Arch Orthop Trauma Surg, 2008, 129(5): 703-709.
18.	Augustin G, Davila S, Mihoci K, et al. Thermal osteonecrosis and bone drilling parameters revisited. Arch Orthop Trauma Surg, 2008, 128(1): 71-77.
19.	Cosculluela PE, Ebert AM, Varner KE. Dorsomedial bridge plating of Lisfranc injuries. Techniques in Foot and Ankle Surgery, 2009, 8(4): 215-220.
20.	Cottom JM, Hyer CF, Berlet GC. Treatment of Lisfranc fracture dislocations with an interosseous suture button technique: a review of 3 cases. J Foot Ankle Surg, 2008, 47(3): 250-258.
21.	Panchbhavi VK, Vallurupalli S, Yang J, et al. Screw fixation compared with suture-button fixation of isolated Lisfranc ligament injuries. J Bone Joint Surg (Am), 2009, 91(5): 1143-1148.

1. Hardcastle PH, Reschauer R, Kutscha-Lissberg E, et al. Injuries to the tarsometatarsal joint. Incidence, classification and treatment. J Bone Joint Surg (Br), 1982, 64(3): 349-356.
2. Teng AL, Pinzur MS, Lomasney L, et al. Functional outcome following anatomic restoration of tarsal-metatarsal fracture dislocation. Foot Ankle Int, 2002, 23(10): 922-926.
3. Chiodo CP, Myerson MS. Developments and advances in the diagnosis and treatment of injuries to the tarsometatarsal joint. Orthop Clin North Am, 2001, 32(1): 11-20.
4. Kuo RS, Tejwani NC, Digiovanni CW, et al. Outcome after open reduction and internal fixation of Lisfranc joint injuries. J Bone Joint Surg (Am), 2000, 82-A(11): 1609-1618.
5. Pereira CJ, Espinosa EG, Miranda I, et al. Evaluation of the surgical treatment of Lisfranc joint fracture-dislocation. Acta Ortop Bras, 2008, 16: 93-97.
6. Rammelt S, Schneiders W, Schikore H, et al. Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation. J Bone Joint Surg (Br), 2008, 90(11): 1499-1506.
7. Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study. J Bone Joint Surg (Am), 2006, 88(3): 514-520.
8. Richter M, Thermann H, Hüfner T, et al. Aetiology, treatment and outcome in Lisfranc joint dislocations and fracture dislocations. Foot Ankle Surg, 2002, 8(1): 21-32.
9. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg (Am), 1976, 58(4): 453-458.
10. Myerson MS, Fisher RT, Burgess AR, et al. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle, 1986, 6(5): 225-242.
11. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
12. Faciszewski T, Burks RT, Manaster BJ. Subtle injuries of the Lisfranc joint. J Bone Joint Surg (Am), 1990, 72(10): 1519-1522.
13. Sands AK, Grose A. Lisfranc injuries. Injury, 2004, 35(Suppl 2): SB71-76.
14. Lee CA, Birkedal JP, Dickerson EA, et al. Stabilization of Lisfranc joint injuries: a biomechanical study. Foot Ankle Int, 2004, 25(5): 365-370.
15. Thordarson DB. Lisfranc ORIF with absorbable fixation. Techniques in Foot and Ankle Surgery, 2003, 2(1): 21-26.
16. Borazjani BH, Chen AC, Bae WC, et al. Effect of impact on chondrocyte viability during insertion of human osteochondral grafts. J Bone Joint Surg (Am), 2006, 88(9): 1934-1943.
17. Augustin G, Davila S, Udiljak T, et al. Determination of spatial distribution of increase in bone temperature during drilling by infrared thermography: preliminary report. Arch Orthop Trauma Surg, 2008, 129(5): 703-709.
18. Augustin G, Davila S, Mihoci K, et al. Thermal osteonecrosis and bone drilling parameters revisited. Arch Orthop Trauma Surg, 2008, 128(1): 71-77.
19. Cosculluela PE, Ebert AM, Varner KE. Dorsomedial bridge plating of Lisfranc injuries. Techniques in Foot and Ankle Surgery, 2009, 8(4): 215-220.
20. Cottom JM, Hyer CF, Berlet GC. Treatment of Lisfranc fracture dislocations with an interosseous suture button technique: a review of 3 cases. J Foot Ankle Surg, 2008, 47(3): 250-258.
21. Panchbhavi VK, Vallurupalli S, Yang J, et al. Screw fixation compared with suture-button fixation of isolated Lisfranc ligament injuries. J Bone Joint Surg (Am), 2009, 91(5): 1143-1148.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL AND RADIOGRAPHIC EVALUATION OF OPEN REDUCTION AND INTERNAL FIXATION WITH HEADLESS COMPRESSION SCREWS IN TREATMENT OF Lisfranc JOINT INJURIES

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