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Review Question - QID 764

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QID 764 (Type "764" in App Search)
A 37-year-old man was involved in a high velocity motor vehicle accident 6 months ago. He spent 4 months in the ICU recovering from a severe head injury. He has now transitioned to a rehabilitation hospital and complains of left foot pain that becomes severe with weightbearing and attempted ambulation. Radiographs are provided in figures A-C. Which of the following is the best management?
  • A
  • B
  • C

Custom orthotics and physical therapy

1%

17/2498

Closed reduction and percutaneous screw fixation of 1st through 3rd tarsometatarsal joints

2%

51/2498

Open reduction internal fixation of 1st through 3rd tarsometatarsal joints

19%

466/2498

Arthrodesis of 1st through 3rd tarsometatarsal joints

74%

1855/2498

Tarsometatarsal arthrodesis and triple arthrodesis

3%

87/2498

  • A
  • B
  • C

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The clinical presentation and radiographs present a Lisfranc (tarsometatarsal dislocation) injury that is 6 months old. The first, second, and third tarsometatarsal articulations are involved. Given the chronicity of the injury, arthrodesis is the best treatment option available to relieve pain and improve function. There is no indication to include a triple arthrodesis with the tarsometatarsal arthrodesis.

The Mulier article compared total arthrodesis (medial + lateral) vs medial column arthrodesis with lateral column ORIF for severe Lisfranc injuries. They found inferior outcomes with total arthrodesis.

Komenda et al reviewed 32 patients who underwent tarsometatarsal arthrodesis at a minimum of 6 months following injury. The patients improved significantly compared to the preoperative pain and function. However, a number of complications were encountered including neuritis, malunion, nonunion, wound sloughing, and RSD.


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