Indirect fixation of the third tarsometatarsal joint for high-energy Lisfranc injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIA Jiang , LI Bing , ZHOU Haichao , YU Tao , YU Guangrong ,  YANG Yunfeng

Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China;

Corresponding author：

YANG Yunfeng, Email: dr.yangyf@hotmail.com

Keywords：

Lisfranc injury; high-energy injury; internal fixation; the 3rd tarsometatarsal joint; intermetatarsal ligament

DOI：

10.7507/1002-1892.202009066

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Objective To evaluate the effectiveness of indirect fixation of the 3rd tarsometatarsal joint in the treatment of high-energy Lisfranc injury.Methods Between February 2015 and February 2019, 15 patients with high-energy Lisfranc injury were treated. There were 12 males and 3 females with an average age of 44.8 years (range, 29-73 years). The average time from injury to admission was 8.8 hours (range, 2-28 hours). According to Myerson classification, there were 6 cases of type A, 4 cases of type B2, 1 case of type C1, and 4 cases of type C2; 8 cases were open injury. The 3rd tarsometatarsal joint was injured in all patients, including intact intermetatarsal ligament in 7 cases, the 2nd-3rd intermetatarsal ligament injury in 6 cases, the 3rd-4th intermetatarsal ligament injury in 1 case, and the 2nd-3rd-4th intermetatarsal ligament injury in 1 case. Among them, the 3rd tarsometatarsal joint was not fixed directly and indirectly fixed by stabilized the 2nd and 4th tarsometatarsal joints in 13 cases. The 3rd tarsometatarsal joint was fixed with Kirschner wire in 2 cases for 1 patient had complete injury of the intermetatarsal ligament and the other 1 had comminuted fracture of the base of the 3rd metatarsal. The reduction of fracture and dislocation was evaluated by X-ray films, focusing on the re-displacement of the 3rd tarsometatarsal joint. The effectiveness was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score.Results Thirteen of the 15 patients were followed up 12-26 months, with an average of 15.6 months. One case had superficial infection of the incision and healed after symptomatic treatment; the other incisions healed by first intention. At last follow-up, the VAS score was 0-3 (mean, 1.1) and the AOFAS score was 70-99 (mean, 87.5). Twelve patients achieved anatomical reduction and 1 patient had increased talar-first metatarsal angle and the mild forefoot abduction. During the follow-up, no loss of reduction of the 3rd tarsometatarsal joint was found, while the spontaneous fusion of the joint was observed in 2 patients.Conclusion In high-energy Lisfranc injury, as long as the intermetatarsal ligament is not completely destroyed and the bony structure of the tarsometatarsal joint is intact, the 3rd tarsometatarsal joint does not need to be fixed routinely, the stability of the joint can be obtained indirectly by fixing the adjacent tarsometatarsal joint.

Citation： XIA Jiang, LI Bing, ZHOU Haichao, YU Tao, YU Guangrong, YANG Yunfeng. Indirect fixation of the third tarsometatarsal joint for high-energy Lisfranc injury. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(4): 426-430. doi: 10.7507/1002-1892.202009066 Copy

1.	Qu W, Ni S, Wang Z, et al. Severe open Lisfranc injuries: one-stage operation through internal fixation associated with vacuum sealing drainage. J Orthop Surg Res, 2016, 11(1): 134.
2.	Mulcahy H. Lisfranc injury: current concepts. Radiol Clin North Am, 2018, 56(6): 859-876.
3.	Coetzee JC, Ly TV. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. Surgical technique. J Bone Joint Surg (Am), 2007, 89(Suppl 2 Pt 1): 122-127.
4.	de Palma L, Santucci A, Sabetta SP, et al. Anatomy of the Lisfranc joint complex. Foot Ankle Int, 1997, 18(6): 356-364.
5.	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.
6.	Stern RE, Assal M. Dorsal multiple plating without routine transarticular screws for fixation of Lisfranc injury. Orthopedics, 2014, 37(12): 815-819.
7.	Kirzner N, Zotov P, Goldbloom D, et al. Dorsal bridge plating or transarticular screws for Lisfranc fracture dislocations: a retrospective study comparing functional and radiological outcomes. Bone Joint J, 2018, 100-B(4): 468-474.
8.	Philpott A, Lawford C, Lau SC, et al. Modified dorsal approach in the management of Lisfranc injuries. Foot Ankle Int, 2018, 39(5): 573-584.
9.	Herscovici D, Scaduto JM. Acute management of high-energy lisfranc injuries: A simple approach. Injury, 2018, 49(2): 420-424.
10.	Castro M, Melão L, Canella C, et al. Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. AJR Am J Roentgenol, 2010, 195(6): W447-455.
11.	Mayne AIW, Lawton R, Dalgleish S, et al. Stability of Lisfranc injury fixation in Thiel Cadavers: Is routine fixation of the 1st and 3rd tarsometatarsal joint necessary? Injury, 2017, 48(8): 1764-1767.
12.	Ouzounian TJ, Shereff MJ. In vitro determination of midfoot motion. Foot Ankle, 1989, 10(3): 140-146.
13.	Abbasian MR, Paradies F, Weber M, et al. Temporary internal fixation for ligamentous and osseous Lisfranc injuries: outcome and technical tip. Foot Ankle Int, 2015, 36(8): 976-983.
14.	Nithyananth M, Boopalan PR, Titus VT, et al. Long-term outcome of high-energy open Lisfranc injuries: a retrospective study. J Trauma, 2011, 70(3): 710-716.
15.	李中万, 洪劲松, 杨勤梦, 等. Lisfranc 损伤切开复位螺钉内固定术后跖跗关节症状性骨关节炎的观察. 中华创伤骨科杂志, 2018, 20(1): 45-49.
16.	Lau S, Guest C, Hall M, et al. Functional outcomes post Lisfranc injury-transarticular screws, dorsal bridge plating or combination treatment? J Orthop Trauma, 2017, 31(8): 447-452.
17.	Gu W, Shi Z. Staged management of open Lisfranc injury: Experience from 14 patients. Medicine (Baltimore), 2017, 96(17): e6699.

1. Qu W, Ni S, Wang Z, et al. Severe open Lisfranc injuries: one-stage operation through internal fixation associated with vacuum sealing drainage. J Orthop Surg Res, 2016, 11(1): 134.
2. Mulcahy H. Lisfranc injury: current concepts. Radiol Clin North Am, 2018, 56(6): 859-876.
3. Coetzee JC, Ly TV. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. Surgical technique. J Bone Joint Surg (Am), 2007, 89(Suppl 2 Pt 1): 122-127.
4. de Palma L, Santucci A, Sabetta SP, et al. Anatomy of the Lisfranc joint complex. Foot Ankle Int, 1997, 18(6): 356-364.
5. 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.
6. Stern RE, Assal M. Dorsal multiple plating without routine transarticular screws for fixation of Lisfranc injury. Orthopedics, 2014, 37(12): 815-819.
7. Kirzner N, Zotov P, Goldbloom D, et al. Dorsal bridge plating or transarticular screws for Lisfranc fracture dislocations: a retrospective study comparing functional and radiological outcomes. Bone Joint J, 2018, 100-B(4): 468-474.
8. Philpott A, Lawford C, Lau SC, et al. Modified dorsal approach in the management of Lisfranc injuries. Foot Ankle Int, 2018, 39(5): 573-584.
9. Herscovici D, Scaduto JM. Acute management of high-energy lisfranc injuries: A simple approach. Injury, 2018, 49(2): 420-424.
10. Castro M, Melão L, Canella C, et al. Lisfranc joint ligamentous complex: MRI with anatomic correlation in cadavers. AJR Am J Roentgenol, 2010, 195(6): W447-455.
11. Mayne AIW, Lawton R, Dalgleish S, et al. Stability of Lisfranc injury fixation in Thiel Cadavers: Is routine fixation of the 1st and 3rd tarsometatarsal joint necessary? Injury, 2017, 48(8): 1764-1767.
12. Ouzounian TJ, Shereff MJ. In vitro determination of midfoot motion. Foot Ankle, 1989, 10(3): 140-146.
13. Abbasian MR, Paradies F, Weber M, et al. Temporary internal fixation for ligamentous and osseous Lisfranc injuries: outcome and technical tip. Foot Ankle Int, 2015, 36(8): 976-983.
14. Nithyananth M, Boopalan PR, Titus VT, et al. Long-term outcome of high-energy open Lisfranc injuries: a retrospective study. J Trauma, 2011, 70(3): 710-716.
15. 李中万, 洪劲松, 杨勤梦, 等. Lisfranc 损伤切开复位螺钉内固定术后跖跗关节症状性骨关节炎的观察. 中华创伤骨科杂志, 2018, 20(1): 45-49.
16. Lau S, Guest C, Hall M, et al. Functional outcomes post Lisfranc injury-transarticular screws, dorsal bridge plating or combination treatment? J Orthop Trauma, 2017, 31(8): 447-452.
17. Gu W, Shi Z. Staged management of open Lisfranc injury: Experience from 14 patients. Medicine (Baltimore), 2017, 96(17): e6699.

Chinese Journal of Reparative and Reconstructive Surgery

Indirect fixation of the third tarsometatarsal joint for high-energy Lisfranc injury

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