title: Influence of approach and implant on reduction accuracy and stability in lisfranc fracture-dislocation at the tarsometatarsal joint.
abstract: BACKGROUND
  Besides early diagnosis, an anatomical and stable reduction is paramount for obtaining a favorable outcome. The current study looked at the influence that the type of approach for tarsometatarsal injuries has on the accuracy of the reduction and the effect that the type of fixation has on stability.
  
  
  METHODS
  Consecutive patients treated surgically for an acute Lisfranc injury were included. All radiographs were reassessed for accuracy and secondary displacement following either a closed or an open approach and in terms of the type of fixation (Kirschner wires alone or a combination of screws and plates and Kirschner wires). A total of 28 patients were included. Six patients were treated with closed reduction and percutaneous fixation and 22 with open reduction internal fixation. Sixteen patients were treated with Kirschner wires only (6 closed, 10 open), 7 with screws with or without Kirschner wires, and 5 with medial plating with or without Kirschner wires.
  
  
  RESULTS
  In the closed reduction group, 2 of 6 (33%) reductions were considered acceptable versus 19 of 22 (86%) in the open group (P = .021). All 6 secondary displacements occurred in the Kirschner wire fixation group (37.5%) versus none in the rigid fixation group (P = .024).
  
  
  CONCLUSIONS
  The results demonstrate that open reduction and internal fixation with screws or plate resulted in better reduction and better maintenance of reduction in both low- and high-energy Lisfranc injuries. These results should be further evaluated in light of functional outcome.
  
  
  METHODS
  Level III, retrospective comparative case series.
authors: Department of Surgery-Traumatology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands. t.schepers@erasmusmc.nl
authors: Tim
authors: T
authors: Schepers
authors: Pim P
authors: PP
authors: Oprel
authors: Esther M M
authors: EM
authors: Van Lieshout
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D033023:Foot Joints / Q000293:injuries*; D005593:Fracture Fixation, Internal; D006801:Humans; D016268:Internal Fixators; D057072:Intra-Articular Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D004204:Joint Dislocations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Lisfranc; accuracy; open reduction and internal fixation; stability; tarsometatarsal