Introduction
Dislocations and fracture-dislocations of the tarsometatarsal joints are disabling injuries that present difficult therapeutic problems. Early recognition is imperative. Most studies cite that up to 20% of injuries are missed or misdiagnosed at first presentation; this number could be as high as 40%.
Patients and methods
This study included all patients who presented with misdiagnosed or mismanaged Lisferanc injuries to Suez Canal University Hospital during the period from May 2002 to March 2006. Patients’ outcomes were assessed using the American Orthopedic Foot and Ankle Society midfoot score. A total of 19 patients were available at the end of the study.
Results
The mean age of the patients was 34.05±11.76 years including 17 (89.5%) men and two (10.5%) women. There were 17 patients with combined injury (ligament and bone) and two patients with pure ligamentous injury. The patients were distributed according to the modified Hardcastle classification. There were nine (47.4%) patients with type B lateral fractures; two of these showed fleck sign, six (31.6%) patients with type A lateral fracture, three patients with type C total fracture dislocation, and one (5.3%) patient with type C partial fracture. Four (21.1%) patients were managed after the first week of injury, nine (47.4%) patients were managed between the second week of injury and the seventh week, and six patients were managed after the seventh week of the injury. Four (21.1%) patients developed osteoarthrosis at the end of follow-up.
Conclusion
Lisferanc injuries are reported to be the most commonly missed injury. Once diagnosed, anatomical reduction and stable fixation is the standard principle governing the treatment of these injuries.