THE OUTCOME OF K-WIRE FIXATION OF TARSOMETATARSAL INJURIES

Abstract

Lisfranc injuries make up 0.2% of all fractures. With or without midfoot injuries, treatment requires early accurate diagnosis, anatomical reduction and stable internal fixation. Some surgeons prefer K-wire fixation, while others rely on rigid screw fixation, especially of the medial column. To assess the radiological and functional outcome of K-wire fixation of Lisfranc injuries, we carried out a prospective study between January 1999 and December 2000.

The ages of our 15 male and four female patients ranged from 15 to 47 years. Using the Quenu and Kuss system to classify injuries, we treated five isolated, nine homolateral and five divergent injuries. In eight patients there were associated midfoot injuries, and four had compound fractures. We treated 11 fractures with closed reduction and K-wires. Open reduction with K-wire fixation was carried out on eight fractures, including the four compound fractures, within 19 days of admission. All patients were kept non-weight-bearing in a short backslab, and the wires removed at six weeks. Follow-up times ranged from 4 to 19 months.

To assess functional outcome we used the American Orthopaedic Foot and Ankle Society’s midfoot scoring system, which has a maximum score of 100. The mean score of our patients was 70 (52 to 85). Mild or occasional foot pain and slight gait abnormality resulted in limitation of recreational activities. At three months, 15 patients were fully weight-bearing. A single case of superficial sepsis resolved, and there were no cases of implant failure or loss of reduction.

K-wire fixation following anatomical reduction is a satisfactory option for the treatment of tarsometatarsal injuries, especially when severe injuries involve the midfoot. The technique is minimally invasive and the K-wires are easily inserted and removed.