SLR - October 2021 - Elie Touma

A Mid-Term Follow-Up Retrospective Evaluation of Tarsometatarsal Joint Fracture-Dislocations Treated by Closed Reduction and Percutaneous K-Wires Fixation

Reference: Mosca M, Fuiano M, Censoni D, Marcheggiani Muccioli GM, Roberti di Sarsina T, Grassi A, Caravelli S, Zaffagnini S. A Mid-Term Follow-Up Retrospective Evaluation of Tarsometatarsal Joint Fracture-Dislocations Treated by Closed Reduction and Percutaneous K-Wires Fixation. Injury. 2021 Jun;52(6):1635-1640. doi: 10.1016/j.injury.2020.10.040. Epub 2020 Oct 8. PMID: 33070946.

Level of Evidence: Level 4

Scientific Literature Review

Reviewed By: Elie Touma, DPM 
Residency Program: Northwest Medical Center – Margate, FL

Podiatric Relevance: The treatment options of acute Lisfranc injuries are a commonly discussed topic amongst foot and ankle surgeons. The most common treatment options for acute Lisfranc injuries are open reduction and internal fixation (ORIF) with the use of transarticular screw fixation and arthrodesis. Patients should be aware of the possible complications they may face such as wound dehiscence, hardware failure, and possible deep soft tissue damage with ORIF treatment. These complications are especially important for those who have comorbidities like diabetes and peripheral vascular diseases who cannot afford to have these types of complications. The authors of this study wanted to evaluate the results following the treatment of Lisfranc injuries with closed reduction and percutaneous k wire fixation. 

Methods: This study is a retrospective review of patients treated with closed reduction and percutaneous wire fixation of tarsometatarsal injures from 2014 to 2018. Patients were excluded if they had a fusion in either the foot or ankle joint, foot deformities caused by diabetes, rheumatoid diseases, open fracture, or fasciotomies. Fracture reduction was corrected when there was noted congruity at the corresponding joints on midfoot x-rays. Patients were evaluated at follow up with American Orthopedic Foot and Ankle Society (AOFAS) midfoot score, Visual Analogue Scale (VAS) and x-rays. Post operatively they were instructed to be non-weight bearing for six weeks. At six weeks, k wires were removed and after 12 weeks in a walking boot, patients were transitioned to full weight bearing in comfortable shoes.

Results: A total of 15 patients met the inclusion criteria and were treated. Majority of the patients were cigarette smokers and only two were diabetics. The types of fracture were based on Hardcastle Myerson classifications and they included 7 Type A, 3 Type B1, 4 Type B2 and 1 type C1. Mechanism of injury varied from motor vehicle accidents, falls, work activity, and sport injury. The fractures did include the metatarsals, medial, middle cuneiform, and metatarsal cuneiform joints. Clinically, at the final follow up, they had good-excellent AOFAS and VAS scores with only a single patient that needed to be treated later with fusion. Complications included a DVT and two incidences of CRPS. No skin, local nerve or deep tissue damage were noted.

Conclusions: Even though closed reduction and percutaneous k wire fixation are not common treatment options when compared to transarticular screw fixation or primary arthrodesis, it is still a feasible option to achieve proper anatomic reduction. This treatment option can be a good bail out when surgeons run out of options intraoperatively. K-wire fixation can be utilized but surgeons should remember that they offer very little stability, and pin tract infection and pseudoaneurysms are still possible. The percutaneous approach is challenging and should be avoided if multiple attempts are made. Limitations that the authors point out were that only 15 patients were included and the fact that it was retrospective in design. Lisfranc injuries can be considered life altering fractures and patients should be aware that their first surgery may not be their last.

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