Download A DANGEROUS TYPE OF FRACTURE OF THE FOOT the plantar

A
DANGEROUS
TYPE
\VILLIAM
GISSANE,
From
The
Lisfranc
of arterial
shown
or
by
the
When
the
wide
terminal
arterial
part
damage
of soft
to this
supply
of the
junction
in all
Lisfranc
of the
dorsalis
with
degrees
a dangerous
excessive
artery
or
medial
however,
injury
may
tibial
at
further
be
the
ankle
During
by
limbs-that
33 B,
is,
NO.
main
ten
years
recognised
FIG.
1
NOVEMBER
1951
of the
with
foot
superimposed.
pedis
artery
(not
with
and
(Fig.
is not
some
second
1), must
the
foot
the
degree
metatarsals,
mean
plantar
damage
arterial
arch.
in jeopardy.
There
arterial
The
shown)
the
plantar
arterial
of this
fracture
and
division
at its
arch
is present
is not
in itself
precarious.
lateral
we
rest,
of
to the
cold
this
division
vessel,
have
conservative
bed
bones
as it joins
life
fracture
displacement
the
elevation,
4,
of
in addition
last
these
the
associated
first
injury.
When
to this
injury
is added
torsion
of
the
main
lateral
plantar
of the
posterior
tibial
artery
behind
the
malleolus,
the
blood
supply
of tile
foot
and
or
the
displacement,
degrees
great,
be
the
artery
site
becomes
are,
always
between
pedis
FOOT
Hospital
will
between
dorsalis
is confined
Displaced
foot
THE
ENGLAND
Accident
tissues
separation
of the
OF
BIRMINGHAM,
of the
tearing
characteristic
of the
the
gross
FRACTURE
the Birmingham
fracture-dislocation
damage;
division
OF
fracture
of the
or both,
treated
methods
packs
may
three
and
in
be
back
the
pedis
associated
artery,
arterial
the
posterior
injured.
Lisfranc
for
which
dorsalis
fractures,
treatment
splints-and
with
of
each
very
grossly
has
gross
swollen
ended
in
a
535
536
w.
below-knee
amputation.
in consequence
believe
The
of this,
to be the
last
we have
anatomy
foot
so treated
reviewed
of this
GISSANE
our
It
is submitted
are
displacements
and that
displacement
Evidence
artery
and
that
at the
was
the
fourth
day
the
medial
malleolus
a large
In
patient
the
the
During
the
last
successful.
an
attempt,
In
and so regain
been subjected
and
artery
arterial
we have
not
incision
is centred
exploration
of the
of the
foot,
approach
the
latter
blood
tied.
first
metatarsal
are
their
normal
position
and one of the reasons
need
for
the
“key”
still
to
open
had
also
remains
the
In
2 and
to
the
major
surfaces
from
the
3).
the
this
so
the
dorsal
first
far
patient
held
After
the
the
deformity
the
been
the
on
behind
evacuation
of
vessel.
metatarsal
space
foot.
severe
and
to this
tissue
tibia!
of the
first
more
tissue
exposed
the
of the
the
vessel;
soft
posterior
was
and
dangerous
fracture
bone
of displacement,
to use for the
and
will
be
displacements
two patients
have
major
displacements.
forces
causing
foot
and
surface
of
the
(the
other
is to
release
2 to
4)
of the
mechanism
of the
of the
easy,
a screw
the
used
the
tarsal
in
important
reduction
internal
to
fracture
is fixed
transverse
more
The
was
associated
or
replaced
displacements,
perhaps
but
are
cuneiform
and
tension).
this
vessels
medial
approach
and
aspect
Through
bleeding
the
allows
plantar
injury.
any
reduction
This
and
the
of the
remarkably
(Figs.
cuneiform.
space
of the
to
“
medial
metatarsal
aspect
reduction
“key”
plantar
and
treatment
approach
dorsal
displacements
has
correct
is
of his foot
by
local
at
soft
first
by the
both
through
displacements
and
medially)
of
dissected
from
the
fracture
OPERATION
“
in
we
crushing
force,
of displacement
as the
artery
death
with
new
metatarsal
we believe
is the
key
open reduction
is essential
metatarsal
(Figs.
(rotated
base
by
divided
the
OF
bone
unrelieved
in the
a patient
first
lateral
the
as high
and
been
reconstruct
plantarwards
a problem.
second
cuneiform
already
; this
why
was
our
on the
tibial
foot
resulted
that
the
of the
retrieved
reduction
bone
over
is evacuated
displaced
and,
on what
Lisfranc
to decompression
foot in the lesser degrees
open reduction
we plan
aspect
being
clot
Fragments
the
dorsal
which
of the
received
to
at least
posterior
sole
TECHNIQUE
A medial
strain
submitted
the
evidence
however,
functional
emergency
dissection
approach
as the
corrected
extend
injuries
submit
a better
to the
known
torsion
to be in spasm,
pedis
year
cannot
can
operation
dorsum
of these
and
a heavy
in a patient
found
the
wound
of the forefoot
main vessels.
vessels
At the
dorsalis
combination
displacements
to the
and
from
a new
to the forefoot
and not by direct
even in their most extreme
forms
placed
demonstrated
injury.
haematoma
this
and
after
to detailed
base
are, the skin wound
has been caused
by a force from within
violence.
2) At the examination
of the dissected
foot it
or pronation
of the forefoot
increased
the bone and soft
or supination
torsion
on the
damage
ankle
INJURY
closed
violence
fractures
obviously
medial
rotation
and released
THE
OF
complicated
and, when they
direct
crushing
lateral
rotation
open
not
by a
found
that
tissue
the
by excessive
lateral
rotation
following
reasons
: 1) These
seldom
and
was
that
subjected
and
injury.
ANATOMY
caused
for the
was
methods
of
fixation
fix the
of the
first
medial
forefoot
is supinated
and close the gap in
arch
torn
plantar
ligaments.
If secondary
fractures
of the metatarsal
necks
are present
these
are manipulated
to a stable
reduction
by longitudinal
traction
on the foot (Fig. 4). Continuous
traction
to maintain
reduction
of the fractures
of the metatarsal
necks
was not used.
The
final result
in this patient
was a normal
foot.
In the second
patient
(Figs.
5 and 6) the
the
reduction
drilled
the
first
of the
and
more
case.
“key”
displacement
a stout
silk mattress
stable
first metatarsal.
was
suture
The
again
easy,
the
second
used to maintain
the
rest of the procedure
THE
JOURNAL
and
first
displaced
followed
OF
metatarsals
metatarsals
that
outlined
BONE
AND
JOINT
were
over to
in the
SURGERY
A
DANGEROUS
TYPE
OF
FRACTURE
FIG.
FIG.
Case
1. Figure
of the dorsalis
operation)-The
before
VOL.
33 B,
NO.
reduction
4,
NOVEMBER
THE
the
FIG.
fracture
with
minor
in the first
space
was
displacement
corrected
metatarsal
fractures
by
4-Final
1951
result.
Normal
537
FOOT
2
3
2-Lisfranc
pedis
artery
“key”
of
Figure
OF
displacement.
At
4
operation
rupture
found.
Figure
3 (radiograph
during
and
the fragments
held
by a screw,
longitudinal
traction
and
pronation.
function
was
regained.
538
W.
GISSANE
‘V
FIG.
Case
2.
Figure
stable
Figure
6-’
first
5
5-()riginal
Key
bony
‘ ‘
FIG.
displacement
was
displacements
Radiograph
metatarsal.
Six
of
held
taken
months
by
tile
degree,
silk mattress
the forefoot
after
later
minor
function
of
but
the
dorsalis
6
pedis
the
was
artery
suture
between
second
had been
pronated
and
foot
was almost
normal.
ruptured.
and
more
in plaster.
metatarsal
immobilised
DISCUSSION
The
the
purpose
more
severe
twisting
of
vessels
rotation
elements
of ankle
of
it,
such
are
long
the
lower
limb
particularly
when
immobilised
to
such
in unpadded
to
On
to
in
spiral
the
lower
report
most
common
excessive
that
and
the
danger
and
foot.
Council
is the
threaten
real
damage
and
is so excessive
subjected
as to
the
of
Research
violence
damage
of
axis
the
fracture
irreparable
fracture
the
stress
Lisfranc
vessels
for
(National
twisting
is to
of
main
around
locomotion
to
the
types
paper
types
is responsible
rotations
this
of this
life
of
injuries
are
rare
the
of
are
cause
of lower
at
the
twisting
reduced
by
same
tibia
that
matter
closed
in
fibula.
rotation
of
the
normal
various
Very
injury,
rarely
or proximal
their
division
a medico-legal
methods
main
lateral
in
of
cause
in
to
Transverse
fractures.
of bone
foot
due
gross
movements
may
has
is
twisting
foot
and
limb
site
of the
damage
of the
Excessive
vessels
This
the
the
supply
the
physiological
1947).
limb.
blood
that
supply
fractures
dangerous
the
occasions
blood
limb
blood
the
to
suggest
or
significance,
and
the
limbs
are
plaster.
REFERENCE
Fundamental
California,
Studies
in
Human
Locomotion.
Report
to
the
National
Research
Council,
University
1947
THE
JOURNAL
OF
BONE
AND
JOINT
SURGERY
of