Chopart- und Lisfranc-Luxationsverletzungen – operative Zugangswege, Lagerungstechniken sowie intraoperative Erfolgskontrolle

Zusammenfassung

Eine hohe Zahl von Kombinationsverletzungen der Fußwurzel wird primär nicht erkannt (20 – 25%). Insbesondere Luxationsfrakturen sind folgenschwere Verletzungen und können mit erheblichen funktionellen Einschränkungen verbunden sein. Eine suffiziente Primärdiagnostik beinhaltet Standardröntgenaufnahmen des Fußes in 3 Ebenen. Bei klinischem Verdacht sollte die Indikation zur erweiterten Schnittbildgebung mittels Computertomografie mit multiplanaren Rekonstruktionen großzügig gestellt werden. Die physiologische Rekonstruktion der Gelenkstrukturen und Lagebeziehungen der medialen zur zentralen und lateralen Fußsäule sowie die Erfassung und Therapie ligamentärer Instabilitäten sind elementare Bestandteile einer adäquaten Behandlung. Können diese Prinzipien nicht erreicht werden, sind Korrekturarthrodesen im Verlauf unvermeidlich. Mittels Bildverstärker können latente Instabilitäten auch im Stresstest dynamisch untersucht werden. Bei chronischen Beschwerden können Belastungsaufnahmen im Stehen helfen, Instabilitäten und Fehlstellungen zu erkennen.

Abstract

A high number of combined or isolated injuries of the front- and midfoot including fractures, dislocations and/or fracture dislocations of the Chopart and Lisfranc joint lines are initially misdiagnosed or overlooked (20 – 25%). Especially fracture dislocations are serious injuries leading to massive impaired functional outcome. A sufficient primary diagnosis including standard conventional X-rays in three planes of the foot (dorso-plantar, lateral and lateral oblique views). If an injury of the front- or midfoot is suspected, CAT scanning and multiplanar reconstruction should be obtained broadly. The physiological reconstruction of the medial to the central and lateral coloumn of the foot is essential as well as the recognition and adequate treatment of concomitant ligamentous instabilities. Chronic instabilities can be determined by weight-bearing radiographs or dynamic assessment revealing manifest displacement and malalignment under load.

Schlüsselwörter

Fußwurzel - Dislokation - Fraktur - Arthrodese - Operationstechnik

Key words

midfoot - dislocations - fractures - fracture fixation - arthrodesis

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