Analysis of late results and gait analysis in patients with surgically treated fractures or fracture-dislocations in the Lisfranc and Chopart joint lines

Tarsal injuries often lead to patient disability. Since these injuries - especially dislocations of the Chopart and Lisfranc joint line – are rare and frequently associated with multiple more severe traumas, they still are frequently overlooked or trivialized. To minimize the danger of lasting patient impairment it is thus important to analyze these injuries more thoroughly. For this study we screened 65 case files of patients who had undergone surgery for tarsal injuries in the Department of Trauma Surgery, Plastic and Reconstructive Surgery at the University Medical Center Goettingen in the years 1996 to 2008. 24 of the patients had suffered an injury of the Chopart joint, 38 of the Lisfranc joint and three of both joint complexes. In the time between March 2009 and February 2010, eight patients of the Chopart group and 21 patients of the Lisfranc group were examined. The patient’s history was taken and a physical examination of the lower extremity performed. Following this, a static analysis, gait analysis and a footprint were made. The clinical outcome was determined by the "Clinical Rating Systems for the Midfoot”. From a total of 100 points the Chopart group reached an average of 66 points, the Lisfranc group of 72 points. If an arthrodesis was performed, the above-mentioned score was even worse in both groups. In the biomechanical study a significantly slowed walking speed could be detected in both groups. In addition, the measured forces and moments showed significantly increased stress on the healthy side. In conclusion this study demonstrates that even with successful surgical treatment pathological long-term changes in standing and walking should be expected, showing that an increased focus on these injuries is important not only in prevention and therapy, but also in the long-term follow-up.2016-04-1