• Yunfeng Yang, Guangrong Yu, Jiaqian Zhou, Bing Li, Haifeng Li, and Xiaozhong Zhu.
• Department of Orthopedics, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China.
• Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Jul 1;25(7):785-8.

ObjectiveTo evaluate the clinical effectiveness of open reduction and internal fixation in the treatment of occult Lisfranc injury.MethodsBetween July 2002 and July 2009, 47 patients with occult Lisfranc injuries underwent open reduction and internal fixation. There were 31 males and 16 females with an average age of 35.6 years (range, 19-66 years). Injuries were caused by traffic accident in 27 cases, falling from height in 11 cases, sport in 16 cases, and crush in 3 cases. The locations were left foot in 18 cases and right foot in 29 cases. Simple medial column was involved in 6 cases, medial and middle columns in 24 cases, middle and lateral columns in 13 cases, and three columns in 4 cases. Base fractures of metatarsal bone were identified in all cases. The time from injury to operation was 4-21 days (mean, 8.6 days). The unstable Lisfranc joints were reduced and fixed by plates, screws, staples, and Kirschner wire through 1 or 2 longitudinal dorsal incisions.ResultsOne case had infection and wound was repaired with flap at 2 weeks after operation; the other wounds healed primarily. Thirty-two patients were followed up 28.3 months on average (range, 12-75 months). The mean time of fracture healing was 12.3 weeks (range, 9-15 weeks). Osteoarthritis at midfoot was found in 15 cases at last follow-up and arthrodesis was not needed. The results were excellent in 9 cases, good in 16 cases, fair in 4 case, and poor in 3 cases according to American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score system; the excellent and good rate was 78.1%. No re-dislocation occurred during the follow-up.ConclusionMore attention should be paid to base fractures of metatarsal bone, operative exploration is conducive to diagnosis of occult Lisfranc injury. Suitable internal fixation should be selected according to injury type and concomitant injury. Anatomical reduction and stable fixation are the keys to reconstruct the joint stability in the initial treatment of occult Lisfranc injury.

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