A novel technique for successful closed reduction of a lisfranc fracture-dislocation

Abstract

The purpose of this study is to present a novel technique for the closed reduction of a divergent Lisfranc fracture-dislocation. Successful closed reduction of this injury limits the morbidity associated with soft tissue compromise that may otherwise delay definitive surgical fixation. A combination of weighted axial traction/counter-traction with a two-stage manipulation of the medial/middle and middle/lateral columns of the mid- and forefoot was performed. A Kling was affixed to the hallux and second ray within closed loops, then mounted to an intravenous pole. Weight was then applied to the distal tibia. Axial traction-counter traction and manual plantar translation with medial to lateral compression were then combined until successful reduction of the first and second metatarsal was achieved. The third, fourth and fifth metatarsals were hyper-dorsiflexed and abducted with subsequent inline manual traction and lateral to medial compression over the base of the metatarsals. This was followed by plantarflexion and adduction to complete the reduction maneuver. : A combination of weighted axial traction/counter-traction with two-stage manipulation of the medial/middle and middle/lateral columns of the mid- and forefoot was performed to successfully reduce a divergent Lisfranc fracture-dislocation. Successful closed reduction avoided the need for acute open reduction and mitigated the risk of soft tissue compromise, neurovascular complication, and compartment syndrome. This novel technique for reduction permitted percutaneous internal fixation due to the satisfactory alignment obtained from the closed reduction maneuver. Early closed reduction obviates the need for acute open reduction and limits soft tissue morbidity. This permits orthopaedic surgeons to non-urgently manage Lisfranc fracture-dislocations with definitive surgical fixation that is amenable to either percutaneous techniques or open reduction and internal fixation.