The treatment of Lisfranc injuries.

Thirty-one patients with fracture-dislocations of the tarsometatarsal joint were examined to assess the functional end results after a mean follow-up of 2.9 years (range 20 to 56 months). Sixty-one percent were polytrauma patients; 39% suffered isolated fractures. Forty-five percent had associated lesions of the tarsal joint complex (Chopart and subtalar joint). According to the Baltimore Painful Foot Scoring System (PFS), 52% achieved an excellent or good result and 48% a fair or poor result. Of the four different treatment modalities, open reduction and temporary screw or K-wire fixation yielded the best results. The major determinants of acceptable results were the type of treatment, type of lesions, the quality of initial reduction and associated involvement of the tarsal joint complex. The extent of the initial injury was the determining factor in the development of late degenerative arthritis. Degenerative changes of the tarsal joint were seen in almost all cases (94%). Such changes were more frequent after temporary screw fixation but did not seem to influence the final results. An initial anatomical reduction did not guarantee excellent results but minimized the chance of late degenerative arthritis. Primary arthrodesis demonstrated no advantage in our series. Although partial arthrodesis may be necessary in severely comminuted joints, it cannot be routinely advocated and should be used as a salvage procedure.