Title: Functional Outcome of Internal Fixation of Lisfranc Fractures

Authors: Vaisakh Vasant Kumar, Manoj Murungodiyil Kunjappan

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.157

Abstract

Background: The occurrence of Lisfranc fractures in our population is increasing with rise in road traffic accidents despite being a rare fracture to see. Diagnosis of these fractures is always a challenge to the treating orthopedician. Few studies have only been done in India on such fractures and that explains the need for research in treating these fractures.

Materials and Methods: This prospective observational study reports the functional outcome of 20 patients operated with internal fixation. 20 patients with Lisfranc fracture fitting for the inclusion criteria who came to Orthopaedic Department of Thrissur medical college between 1/1/2016 and 1/1/2017 were surgically treated with open reduction and internal fixation with transarticular screws. Partial weight bearing was started only after the onset of radiological union. They were followed up clinically and radiologically for six months. Functional outcome was assessed after 6 months using American Orthopaedic Foot and Ankle Society (AOFAS) score.

Results & Discussion: In our study the mean age of males was 29.7 (n=9) and females was 40.2 (n=11).  Equal distribution of cases in case of high energy and low energy injury was seen. Right foot was found to be involved in 60% of cases. Four cases had associated tendon injury and another eight cases had suffered other fractures of foot. Diabetes and hypertension were associated in 4 cases. Five patients had developed significant osteoarthritis following surgery. Average stay in hospital was 17 days. Average AOFAS score was 80.4. Excellent results were obtained for 4 cases (20%) and good results for 11 cases (55%).

Conclusion: Internal fixation is a good method for reducing and fixing Lisfranc fractures early to improve functional results. Early mobilization and proper follow up are also necessary for good functional outcome.

Keywords: Lisfranc fracture ;Internal fixation; Functional outcome; AOFAS score.

References

  1. T.A, Coulibaly M.O, Hoffmann M.F, Fractures and dislocations of the midfoot and forefoot In: Court-Brown, Charles, Heckman. J.D, Mcqueen. M.M, Ricci W.M, Tornetta.P, Rockwood and Green’s Fractures in Adults, Eighth edition, Vol 1, NewYork, Wolter Kluwer, 2015 p.2714-19
  2. Teng AL et al ,Functional outcome post Lisfranc injury: Transarticular screws, Dorsal bridge plating or combination treatment, J Orthop Trauma, 2017 Aug;31(8):447-452
  3. Pereira CJ et al ,Evaluation of Surgical treatment of Lisfranc joint fracture dislocation, Acta Orthop Bras,2008; 16(2):93-97
  4. Jeifreys T et al, Lisfranc fracture dislocation: a clinical and experimental study of tarsometatarsal dislocation and fracture dislocation, J Bone Joint Surg{Br}, 1963;45:546-51
  5. Kuo RS et al ,Outcome after open reduction and internal fixation of Lisfranc joint injuries, J Bone Joint Surg Am, 2000 Nov;82A(11) : 1609-18
  6. Yuen JS et al , Open reduction and temporary rigid internal fixation of Lisfranc fracture dislocation ,Singapore Med J, 2001 Jun;42(6): 255-8.
  7. Ruan YP et al, Evaluation of surgical treatment of Lisfranc injuries, Zhongguo Gu Shong,2011 Feb; 24(2) :167-9.

Corresponding Author

Manoj Murungodiyil Kunjappan

Associate Professor, Department of Orthopaedics, Government Medical College, Thrissur, Kerala