What is Lisfranc Stabilization?
Lisfranc stabilization is a surgical procedure aimed at treating injuries to the Lisfranc joint, which is located in the midfoot. These injuries involve the ligaments and bones that connect the metatarsal bones (long bones in the foot) to the tarsal bones (short bones in the foot). Lisfranc injuries can range from mild ligament strains to severe fractures and dislocations. These injuries often result from twisting of the foot (low-energy injury), a fall from a height, or traumatic motor accidents (high-energy injury). They are significant because they can lead to chronic pain, instability, and arthritis if not treated properly.
Indications for Lisfranc Stabilization
Lisfranc stabilization is recommended when conservative treatments such as rest, ice, compression, and elevation (RICE), along with immobilization have been ineffective in alleviating symptoms of Lisfranc injury. Lisfranc stabilization surgery aims to restore the normal anatomy of the Lisfranc joint and ensure its stability.
Preparation for Lisfranc Stabilization
In general, preparation for Lisfranc stabilization surgery may involve the following:
- A thorough medical evaluation, including a review of your medical history, physical examination of the foot, laboratory tests, any allergies, and any current medications or supplements you are taking.
- Imaging studies such as X-rays, CT scans, or MRI to assess the extent of the injury and plan the surgical approach.
- Instructions on which medications to continue or stop before surgery, especially anticoagulants and nonsteroidal anti-inflammatory drugs (NSAIDs).
- Guidelines on when to stop eating and drinking before the surgery (typically 8-12 hours before).
- Instructions to stop smoking and limit alcohol consumption to improve healing and reduce complications.
Procedure for Lisfranc Stabilization
Lisfranc stabilization surgery is performed to repair injuries to the Lisfranc joint complex, which includes the bones and ligaments connecting the midfoot to the forefoot. In general, the procedure involves the following steps:
- Anesthesia: General anesthesia or regional anesthesia (such as a nerve block) is administered to ensure the patient is pain-free and comfortable throughout the surgery.
- Incision: An incision is made on the top (dorsal) part of the foot to access the Lisfranc joint complex.
- Exposure and Evaluation:
- The soft tissues, including skin and muscle, are carefully retracted to expose the injured joint and surrounding structures.
- The surgeon assesses the extent of damage to the bones and ligaments to determine the best approach for stabilization.
- Reduction/Realignment:
- The dislocated or misaligned bones of the midfoot are realigned into their proper anatomical positions. This may require manual manipulation or the use of specialized instruments. This step is crucial for restoring the normal structure and function of the foot.
- Stabilization/Fixation: Depending on the specific needs of the injury, different fixation techniques may be used to stabilize the bone:
- Screws and Plates: Metal screws and plates are commonly used to hold the bones in their correct positions. These devices provide stability while the bones heal.
- Kirschner Wires (K-wires): Temporary wires may be used in some cases, especially in less severe injuries. They can be removed later in a minor procedure.
- Primary Arthrodesis (Fusion): In severe cases, the surgeon may opt to fuse the damaged joints permanently. This involves removing the damaged cartilage and securing the bones together to promote fusion.
- Soft Tissue Repair:
- Ligament Repair: Any torn or damaged ligaments are repaired using sutures or other fixation devices to restore the stability of the joint.
- Closure:
- Wound Closure: The incision is closed with sutures or staples. Sterile dressings are applied to protect the surgical site.
Postoperative Care and Recovery
In general, postoperative care and recovery may involve the following:
- Immobilization: The foot is typically placed in a splint or cast to immobilize the area and ensure proper healing. Strict non-weight-bearing is advised for about 6-8 weeks to allow for proper healing.
- Pain management: Pain is managed with prescribed medications, including analgesics and anti-inflammatory drugs.
- Monitoring and Follow-Up: Regular follow-up visits are scheduled to monitor the healing process. Imaging studies (X-rays) may be taken periodically to ensure the bones are healing properly and the hardware (fixation devices) remains in place.
- Rehabilitation: Once initial healing is confirmed, physical therapy begins to restore strength, flexibility, and range of motion. Gradual progression to weight-bearing activities as tolerated and guided by the surgeon and physical therapist.
Risks and Complications
Risks and complications associated with Lisfranc stabilization surgery include:
- Infection
- Bleeding
- Hardware failure
- Malunion or nonunion of bones
- Post-traumatic arthritis
- Blood clots or deep vein thrombosis (DVT)
- General anesthesia risks
