Riassunto
Le lesioni dell’articolazione tarso-metatarsale sono note per le difficoltà di diagnosi, di trattamento e per l’elevato tasso di esiti invalidanti. Sono stati proposti diversi tipi di trattamento per queste lesioni; i dati presenti in letteratura non sono univoci nella definizione della qualità della ripresa funzionale.
Scopo di questo lavoro è presentare i risultati ottenuti nella nostra esperienza, confrontandoli con quelli presenti in letteratura al fine di definire un possibile algoritmo terapeutico. Sono stati inclusi solo pazienti con fratturalussazione o lussazione pura della Lisfranc, escludendo i politraumi e i casi con concomitanti lesioni a carico dell’arto inferiore o con esposizione.
In base a quanto osservato, possiamo affermare che: le lesioni della Lisfranc andrebbero trattate con una riduzione a cielo aperto seguita da sintesi interna; la riduzione a cielo chiuso seguita dalla stabilizzazione percutanea è giustificata solo in caso di problemi cutanei o vascolari legati al trauma o a patologie preesistenti; l’artrodesi primaria rappresenta il trattamento di scelta nelle fratture altamente comminute.
Riteniamo che l’ORIF continui a ricoprire il ruolo principale nel trattamento delle lesioni della Lisfranc, mentre l’artrodesi debba essere considerata prevalentemente come un intervento di salvataggio.
Abstract
Tarso-metatarsal joint injuries are often characterised by diagnostic and therapeutic difficulties, and long-term residual functional limitations and disabilities. Various treatment options are proposed by several authors, but the scientific literature provides no clear data.
The objective of this study was to compare our experience with other data available in the literature, in order to define a suitable treatment protocol for Lisfranc injuries. We performed a retrospective study of patients with Lisfranc injury; polytrauma cases and patients with concomitant homolateral lower limb lesions or open fractures were not included.
Our results support the concept that stable anatomical reduction of fracture-dislocations of the Lisfranc joint leads to the best long-term outcomes; closed reduction and K-wire or percutaneous screw fixation are suitable only in special cases, such as trauma-related vascular or cutaneous problems. Primary arthrodesis is recommended for highly complex lesions.
Open reduction and internal fixation is recommended as the treatment for most injuries of the Lisfranc joint: anatomical reduction remains important for a good longterm outcome. Tarso-metatarsal arthrodesis should be considered as salvage procedure in case of painful posttraumatic arthritis with significant functional consequences.
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Bibliografia
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Formica, A., Pelle, S., Magistro, L. et al. Le lesioni della Lisfranc: quale trattamento?. Aggiornamenti 18, 105–114 (2012). https://doi.org/10.1007/s10351-012-0017-x
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DOI: https://doi.org/10.1007/s10351-012-0017-x
Parole chiave
- Articolazione di Lisfranc
- Congruenza articolare tarso-metatarsale
- Sintesi interna
- Artrodesi primaria e secondaria