Detailed Research on the Functional Outcomes of Primary Partial Arthrodesis with Dorsal Multiple Plating in Tarsometatarsal Fractures-dislocations
Lisfranc fractures-dislocations are uncommon injuries while the gold standard of therapy is anatomical reduction and stabilization with a type of implants. The aim of this study is to analyze the outcome of these injuries in long term applying primary partial arthrodesis with dorsal plates. Materials and Methods: Twenty three patients with an average age of 34 years old (mean range 1752 yrs old) were treated for tarsometarsal dislocations in our department. The main cause of injuries was a traffic accident. In three cases the injuries were open (2 cases type II and one case type IIIa). Myerson classification system was used to categorize the type of injury. Three cases were type A injuries, eleven cases type B2, five cases C1 and four cases type C2. Under regional anesthesia all patients underwent open reduction and primary partial arthrodesis with dorsal multiple plates (1st TMT, 2nd TMT, 3rd MTM joints) and Kirschner wire for 4th-5th metatarsal. Postoperatively, a splint was applied for 3 weeks and a functional knee brace for other 5 weeks until radiographic consolidation. Results: The median follow-up was 16 months (range from 12-20 months). The results revealed by the Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society midfoot score (AOFAS) and satisfaction of the patients at six and 12 months. The majority of patients (83%) returned to previews activities in ratio time of 12 months postoperatively. At one year the final mean VAS Score was 1,15(range 0,9-1,7) and AOFAS 82,7 (range 79-87) while satisfaction level was 78,2% (range 1-6). Conclusions: Lisfranc fractures-dislocations untreated or improperly treated lead to disorganization of the foot chronic pain and largely disability. Great suspicion of diagnosing these great varieties of lesions should exist in emergency department. The most crucial factor for therapy of these injuries is anatomical reduction regardless the type of implant. Primary partial arthrodesis with dorsal plates offers high patients’ satisfaction rate with less complications and low possibility of re-operation.
Department of Orthopaedic, General Hospital of Heraklion –Venizeleio, Crete, Greece.
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