WWE wrestler Evan Bourne sustained a midfoot fracture dislocation in a car accident last week. Midfoot fractures, otherwise known as LisFranc fracture dislocations, are career threatening injuries to athletes and heavy laborers alike, even when treated well.
Bourne announced the injury on his own twitter account. One of the tweets read “Broken in 4 spots, dislocated in 5!” He also tweeted out several pictures of the injury that indicate he has undergone a partial open reduction with percutaneous (pin) fixation.
The midfoot is best understood as a Roman Arch (figure 1).
When one of the bones of the midfoot is broken, or one of the ligaments torn, the arch will collapse, guaranteeing arthritis of the midfoot. The collapsed arthritic midfoot is one the most challenging reconstructions in Ankle and Foot surgery. Satisfaction rates after surgery are low as it just never feels right and the push-off power is difficult to generate. Therefore, midfoot fracture dislocations are almost always treated surgically.
In isolated ligament injuries without fracture, the challenge is to identify the torn ligaments. While MRI can be helpful, weight bearing x-rays of the foot give a better picture of stability when compared to the uninjured foot. As an orthopedic surgeon, I believe in an open reduction and internal fixation of the joints with plates and screws to obtain rigid arch support. Occasionally some associated joints require percutaneous (pin fixation). Sometimes the joints are injured so badly that they need to be fused together.
Patients must be kept non-weight bearing for extended periods of time (6 weeks to 3 months) to permit healing after either procedure (fixation or fusion).
It is unknown whether or not Bourne will return to wrestling after this injury but one thing is certain – it’s going to be a long road to recovery.
Lance Silverman, MD
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