Lisfranc fractures refer to injuries involving the tarsometatarsal (Lisfranc) joint, which is formed by the five metatarsal bones and three cuneiform bones of the foot. These injuries typically occur as a result of high-energy impacts or stressful activities, often sports-related. There are two main types of Lisfranc fractures: stable and instable. Stable fractures have fewer than 2mm of displacement and less than 15 degrees of malalignment of the talometatarsal joint. In contrast, unstable fractures exhibit more significant displacement and angulation.
The diagnosis and treatment of Lisfranc fractures are crucial to promote early recovery and prevent long-term complications such as post-traumatic arthritis and foot deformities. A comprehensive approach is necessary, which includes a careful examination, diagnostic imaging, and the selection of the appropriate treatment option.
The preferred method of fixation for stable Lisfranc fractures is closed reduction with percutaneous Kirschner wire (K-wire) fixation. This approach involves the insertion of a K-wire through the base of the metatarsal bone into the adjacent cuneiform bone. A short arm cast is applied to protect the wound and maintain alignment. Follow-up radiography is scheduled at 2 and 6 weeks to monitor the healing process and adjust the treatment plan accordingly.
For unstable Lisfranc fractures, surgical stabilization with anatomic reduction is recommended. This may involve a larger incision for direct access to the Lisfranc joint and the insertion of screws or plates to secure the骨折. The choice of screw or plate depends on the type of fracture and the preference of the surgeon. Postoperative treatment typically includes weight-bearing and a walking boot for 4-6 weeks, followed by physical therapy to regain mobility and strength in the affected ankle and foot.
It is important to note that the surgical approach used for stable and unstable Lisfranc fractures may vary based on factors such as the severity of the injury and the experience of the surgeon. The two most common surgical approaches are the dorsal midfoot approach and the plantar approach.
The overall outcome for patients with Lisfranc fractures depends on factors such as the age of the patient, the type of fracture, the treatment approach, and the follow-up care provided. A high index of suspicion and early diagnosis are crucial for the successful management of Lisfranc injuries, ultimately leading to improved recovery and functional outcomes.
