medjournalМедицинский журналMedical Journal1818-426XБелорусский государственный медицинский университет10.51922/1818-426X.2024.3.42medjournal-187Research ArticleЛЕКЦИИПЕРЕЛОМО-ВЫВИХИ СУСТАВА ЛИСФРАНКАFRACTURES AND DISLOCATIONS OF THE LISFRANCA JOINTСитникА. А.SitnikA. A.КорзунО. А.KorzunO. A.БелецкийА. В.BeleckijA. V.ГерасименкоМ. А.GerasimenkoM. A.ГУ «РНПЦ травматологии и ортопедии»BelarusНациональная академия наук БеларусиBelarusГУ «РНПЦ травматологии и ортопедии»; Национальная академия наук БеларусиBelarus202418062025034249Copyright © Ситник А.А., Корзун О.А., Белецкий А.В., Герасименко М.А., 20252025Ситник А.А., Корзун О.А., Белецкий А.В., Герасименко М.А.Sitnik A.A., Korzun O.A., Beleckij A.V., Gerasimenko M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medjournal.ejournal.by/jour/article/view/187

В статье описывается прикладная анатомия сустава Лисфранка, механогенез повреждений, принципы классификации, диагностики и лечения. Повреждения сустава Лисфранка являются относительно редкими, составляя 0,2 % от всех переломов. Они включают широкий спектр повреждений: от растяжений до переломо-вывихов с существенными сопутствующими повреждениями мягких тканей. При отсутствии должной первичной диагностики и раннего лечения они могут приводить к длительной и стойкой инвалидизации. Первичная рентгенологическая диагностика должна включать три стандартных проекции: тыльно-подошвенную, боковую и прямую проекцию со внутренней ротацией стопы. КТ (особенно трехмерная реконструкция) играет важную роль при предоперационном планировании, а также диагностике повреждений с минимальными смещениями костных фрагментов. При первичном лечении важно устранить грубые смещения плюсневых костей, которые сами по себе могут вызывать нарушения кровоснабжения дистального отдела стопы и/или компартмент-синдром. Закрытая репозиция и фиксация спицами возможна только в качестве первичного метода лечения. В качестве окончательной фиксации основным методом является открытая репозиция и жесткая фиксация (винтами и/или пластинами), которая позволяет восстановить стабильность среднего отдела стопы.

The article provides current data on the applied anatomy of the Lisfranc joint, mechanisms of injury, classification, diagnostics and treatment. Lisfranc joint injuries are relatively rare – just 0,2 % of all fractures. They include wide spectrum of injuries: from ligament tears to complex fracture-dislocations with severe concomitant soft-tissue injuries. Up to one third of injuries are missed during initial examination. When properly not diagnosed and not treated early these injuries may lead to severe disability. Initial radiological diagnostics shall include three standard projections: AP, lateral and AP with foot pronation. CT (especially 3D-reconstructions) play important role in the pre-operative planning, and in the diagnostics of the injuries with only mild displacements. During initial treatment it is important to reduce grobe displacements of the forefoot, which may lead to compartmentsyndrome or disorders of the blood supply of the distal part of foot. Closed reduction and wire fixation is appropriate only as initial emergent treatment. The mainstay of the definitive fixation is the open reduction and solid fixation (with screws and/or plates) which enables the restoration of the middle foot stability.

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The authors declare that there are no conflicts of interest present.