RESUMEN
Tarsometatarsal (Lisfranc) joint injuries are rare but potentially devastating conditions requiring anatomical reduction and internal fixation or arthrodesis. We describe an unusual mechanism involving forced eversion and dorsiflexion on both fully supinated feet resulting in bilateral tarsometatarsal joint injury. The injury pattern involved incongruity between the medial and middle columns extending between the cuneiform bones with associated fracture of the cuboid on the right and the cuboid, os calcis and talus on the left. Operative fixation is discussed and the clinical outcome was good at 4 years post-operatively. We believe this introduces an additional and potentially serious mechanism of injury and pattern of ligamentous and osseous disruption into the pantheon of injuries classed as Lisfranc, which surgeons should be aware of. Furthermore, we recommend attention to the mechanism of injury in consideration with classification to aid in operative reduction and fixation.
Asunto(s)
Articulaciones del Pie/lesiones , Fijación Interna de Fracturas , Fracturas Conminutas/etiología , Fracturas Intraarticulares/diagnóstico , Fracturas Intraarticulares/etiología , Huesos Tarsianos/lesiones , Adulto , Femenino , Fracturas Conminutas/diagnóstico , Fracturas Conminutas/cirugía , Humanos , Fracturas Intraarticulares/cirugíaRESUMEN
In this case an 18-year-old female with cerebral palsy sustained a peri-prosthetic femoral fracture adjacent to a blade plate previously inserted for a femoral varus osteotomy. The injury was treated using a long proximal humeral locking plate. The existing blade plate was removed. The fracture was reduced and held, and a 10-hole PHILOS™ plate applied with near anatomical reduction. There were no post-operative complications. Radiographic union was confirmed at 11 months. To our knowledge, this is the first reported use of a PHILOS™ plate in the management of a femoral peri-prosthetic fracture and successfully demonstrated a straightforward method for revision fixation.