Acute management of high-energy lisfranc injuries: A simple approach

The aims of this study were to (1) describe the use of the K-wire for the initial management of high-energy Lisfranc dislocations or fracture dislocations, (2) to evaluate whether this standalone technique allowed for adequate reduction of these injuries, (3) to evaluate whether reductions were maintained until definitive fixation was performed, (4) and to determine if it contributed to any increase in complications prior to or after definitive fixation.

A retrospective review was performed on all patients who presented with tarsometatarsal injuries from January 2005 through June 2015. Dislocations of the tarso-metatarsal joints were classified as either Type A (total incongruity, homolateral complex), Type B (partial incongruity, homolateral incomplete) or Type C (divergent, total or partial displacement) patterns, with or without associated fractures. For the purposes of this paper, high-energy injuries were defined as patients presenting with either a Type A or Type C (total displacement) dislocations or fracture-dislocation patterns. A total of 176 patients presented with a tarsometatarsal injury. Eighteen patients with divergent or homolateral patterns underwent a staged approach. Fifteen patients were managed exclusively with K-wire fixation. Wound complications, infections or the unexpected need to return to surgery were recorded.

All patients demonstrated an improved alignment using K-wires. There were no compartment syndromes, vascular insufficiency, complications to the skin associated with traction or manipulation, or pin site infections. At definitive fixation, no patient demonstrated a loss in the alignment that had been obtained at the index procedure or had an unexpected return to surgery.

This study demonstrates that high-energy Lisfranc injuries are uncommon and that K-wires are a simple and adequate technique that can be used for initial staged approach of these injuries. The use of 2.0mm K-wires were sufficient to obtain and maintain the reduction until definitive fixation has been obtained, without producing any increase risk for complications.