Abstract
We report a relatively rare case of fracture-dislocation of Lisfranc's and Chopart's joints with some discussions.
The patient was a 55-year-old man who was driving a small van and collided with a shed. His right foot was pinned between the seat and the front of the car. On presentation, closed reduction was attempted under lumber anesthesia, but was unsuccessful. At 11 days after injury, the swelling had subsided and infection of the sutured lacerations had resolved, so open reduction was carried out under lumbar anesthesia. The medial and lateral longitudinal incisions of the right foot were made, after which the fracture-dislocation was reduced as completely as possible and fixed with Kirschner wires. A non-weight-bearing short leg cast was applied for 6 weeks after surgery, and the patient subsequently wore a plantar plate for partial weight-bearing walking. The wires were removed on 9 weeks after operation when bone union appeared to have been achieved.
The fracture-dislocations were visualized on preoperative three-dimensional CT scans, but it was impossible to assess deformation of the tarsal and metatarsal bones. Coronal CT scans of Chopart's joint performed before and after surgery delineated the transverse arch of the foot. Concomitant use of three-dimensional lateral plain XP, which is capable of showing the medial longitudinal arch, made it possible to evaluate the displacement associated with the fractures, the severity of dislocations, and the improvement after reduction.
