Reduction of a fracture-dislocation of Lisfranc's joint by endoprosthetic implantation

The medical literature demonstrates numerous documented cases of post-traumatic arthrosis following comminuted fracture-dislocations at the tarsometatarsal joint(s). Conventionally described reductions and methods of fixation, therefore, lend themselves to less than acceptable results. A newly devised, alternative method of approach to this disabling injury was indicated, and is presented by the authors in the hope of preventing the long-term sequelae commonly seen with this type of injury. After open reduction and remodeling of a severely comminuted fracture-dislocation at the second metatarsal-cuneiform articulation, a modified, double-stemmed Swanson Silastic implant was utilized in order to maintain second ray length and attempt prevention of the usual postinjury osseous consequences, i.e., fusion and arthritic changes. The case presented demonstrates that, after her last clinical evaluation 19 months postoperatively, the patient returned to her normal occupation, and at that time her foot was normal in appearance with no sign of traumatic arthritic change. This procedure thus far has proved to be very rewarding to the patient, and the authors believe it should be considered as an alternative approach in patients who present with injuries of this magnitude.