Percutaneous Lisfranc Surgery for Fractures
Dr. Lopez can perform percutaneous Lisfranc fracture surgery in cases of fractures and/or dislocations. Discover all the steps of the treatment journey.
What is a Lisfranc Fracture?
A Lisfranc fracture corresponds to a fracture of the midfoot (i.e., a fracture of the top of the foot). Less well-known than ankle sprains, sprains, fractures, or Lisfranc fracture/dislocations are nonetheless common. These injuries can be potentially serious because they often affect several joints that make up the Lisfranc.
Lisfranc injuries involve the bones of the midfoot. The Lisfranc joint comprises 5 joints located at the front of the foot and connecting the tarsal bones with the metatarsals. This type of injury can be particularly disabling without proper care, especially if the diagnosis goes unnoticed. If you experience painful trauma to the top of your foot, it is important to consult quickly to ensure you do not have a sprain or Lisfranc fracture.
Dr. Lopez specializes in the management of forefoot, hindfoot pathologies, and sports traumas. In case of suspicion of a Lisfranc injury, he will be able to propose a treatment adapted to your case.
Different Lisfranc Injuries: Fractures, Dislocations, Avulsion Fractures, Sprains…
Traumatic Lisfranc injuries (fractures, sprains, etc.) are generally underdiagnosed because they are often confused with a simple ankle sprain. Although Lisfranc sprains can heal spontaneously, some injuries like Lisfranc fracture/dislocation are severe traumas that require emergency foot and Lisfranc surgery. Lisfranc dislocation can easily go unnoticed even with X-ray images. It is one of the 3 dislocations that are most likely to go unnoticed, along with wrist and shoulder dislocations.
Lisfranc can also be the site of multiple sprains, which are ligament injuries to a joint. Three categories of sprains are generally distinguished:
- Mild sprain: ligament elongation without rupture, commonly referred to as a foot sprain.
- Moderate sprain: partial ligament rupture.
- Severe sprain: complete ligament rupture, which may include bone avulsions.
Lisfranc fractures are characterized by fractures of one or more bones. Associated injuries such as ligament damage or multiple bone avulsions are often present. In cases of severe Lisfranc injury, such as a dislocated or displaced fracture, surgery is often required.
Dislocations often result from violent trauma. The emergency treatment involves reduction and temporary fixation with pins (arthrorisis), which will be removed after 45 or 60 days. Weight-bearing can be resumed after 4 or 6 weeks.
Possible Chronic Developments: Pain and Arthritis
Chronic conditions are often the result of a previous Lisfranc injury, sometimes old ones that progress to midfoot arthritis: the wearing of joint cartilage. When arthritis causes significant pain and major functional impairment, surgery involving Lisfranc arthrodesis is justified. These arthroses can alter foot alignment and promote other conditions such as hallux valgus (bunions) or forefoot pain (metatarsalgia).
Symptoms and Diagnosis of Lisfranc Fracture Possible Chronic Developments
Find out how the diagnosis of Lisfranc fracture is made. Lisfranc fractures can be caused by midfoot torsion, direct trauma, or a dorsal or plantar flexion mechanism of the foot.
Dr. Lopez will conduct a clinical examination of the foot to consider possible diagnoses: sprain, fracture, etc. During this examination, the surgeon may inquire about your symptoms, overall health, and any pain you may be experiencing.
After the trauma, the foot is very swollen, and cutaneous suffering can also occur due to swelling. A dorsal and plantar hematoma will also be observed. The patient complains of very painful feet, and walking is very difficult, if not impossible. In some cases, vascular and neurological disorders may occur.
You may be asked to undergo additional imaging tests to confirm the diagnosis:
- The radiographic assessment is generally negative.
- A CT scan can locate bone avulsions and joint displacements.
- Magnetic resonance imaging (MRI) allows visualization of ligament ruptures and intraosseous edema.
Non-surgical (Orthopedic or Functional) Treatment of Lisfranc Foot Fracture
In some cases, non-surgical treatment of Lisfranc foot fracture may be implemented. Lisfranc sprains without bone displacement can be treated with simple foot immobilization using a resin brace. Foot immobilization should last 3 to 6 weeks.
In the case of a slightly displaced Lisfranc fracture/dislocation, conservative treatment can also be considered, taking into account several factors such as the patient's profile, age, or physical condition. The patient should keep the foot elevated to promote edema reduction. Injection treatment should also be administered against the risk of thrombosis. Dr. Lopez may prescribe medication to relieve pain. Weight-bearing and rehabilitation depend on the diagnosis. The choice of treatment is discussed between the surgeon and the patient.
Minimally Invasive Lisfranc Surgery for Fractures
Depending on the bone and ligament injuries, the surgeon can make small incisions (minimally invasive Lisfranc surgery). In most cases, when minimally invasive Lisfranc surgery is necessary, the percutaneous technique allows for complementary procedures. The surgeon provides complete management of the condition, before, during, and after the surgery.
Before the surgery, you will need to have a consultation with an anesthetist to determine the type of anesthesia that will be used during the operation. The healthcare professional may ask you about your general health, medications, and any contraindications or allergies.
Whenever possible, regional anesthesia will be preferred. This anesthesia involves numbing the nerves of the ankle, thus numbing the operated foot as well as the entire surrounding area, including the toes and a large part of the ankle. This method has several advantages:
- It primarily avoids general anesthesia, which is riskier.
- It also effectively combats pain because the effects of anesthesia persist even after the surgery. This helps limit the intake of painkillers for a certain period.
Before the surgery, you will be placed in the pre-anesthesia room, where the anesthetist will numb the nerves. You will then be placed in the operating room, lying on your back and slightly inclined on the opposite side of the foot to be operated on. To stop the blood flow during the surgery, a tourniquet is applied.
Dr. Lopez will then proceed with Lisfranc fracture surgery. Whenever possible, percutaneous surgery of the foot fracture is preferred. In this case, the surgeon starts by making small incisions just a few millimeters in size on the back of the foot. In the case of a Lisfranc fracture/dislocation, the operation involves reducing and fixing the fracture with screws and plates.
The duration of the procedure ranges from 30 minutes to 2 hours. This duration may change depending on the type of fracture and any difficulties encountered during the surgical procedure.
Following your surgery, you will be prescribed pain relief medication. It is important to take this treatment following the instructions provided by your surgeon. Anticoagulant treatment will also be initiated to reduce the risk of thrombosis. To combat edema, it is imperative to keep the foot elevated after surgery. It is also necessary to apply ice to your foot several times a day.
Three appointments are required following Lisfranc fracture surgery:
- The first appointment on the 21st day, to check the scar and X-ray.
- A second appointment at the 45th or 60th day, for a follow-up visit. You should bring your follow-up X-rays to this appointment.
- A third appointment is often necessary.
In the case of a Lisfranc fracture, rehabilitation with a physiotherapist can begin quickly. The patient can also engage in self-rehabilitation for the Lisfranc fracture independently.
In the case of surgical Lisfranc fractures, orthopedic surgery is generally performed on an outpatient basis. The patient comes to the clinic in the morning of the procedure and can return home in the evening.
After the operation, the operated foot is immobilized for 30 to 60 days using a brace or cast. Weight-bearing is not recommended immediately after the surgery. It can be resumed based on the surgeon's instructions, depending on the procedure performed and the follow-up X-ray.
Driving can typically be resumed approximately 1 to 2 months after minimally invasive foot surgery.
The return to sports can occur from the 8th postoperative week, in the best cases (except for swimming, cycling, and gentle sports).