Complex Foot Injury With Grade III B Compound Fracture Involving Lisfranc And Chopart Fracture Dislocation With Bone Loss Of Middle And Lateral Cuneiform Bones Treated With A Novel Technique Of Tricortical Iliac Bone Graft: A Case Report.

Abstract

Background:
Open fractures of the foot with combined Chopart and Lisfranc fracture-dislocations are rare, limb-threatening injuries that are difficult to manage because of severe contamination, osseous instability, and associated soft-tissue loss. Segmental loss of two cuneiform bones in this setting is exceptionally uncommon, and successful reconstruction with tricortical iliac crest bone grafting has rarely been
described. We report the management and short-term outcome of a young man with Grade IIIB open complex foot trauma involving combined Chopart and Lisfranc fracture-dislocations, loss of the middle and lateral cuneiforms, and extensive soft-tissue damage.
Case Report:
A 22-year-old man sustained a road traffic injury to the right foot and presented with a Grade IIIB open injury characterized by combined Chopart and Lisfranc fracture-dislocations, severe contamination with grass particles, extensive soft-tissue injury, loss of the middle and lateral cuneiform bones, and loss of the extensor digitorum tendon. Emergency management included thorough debridement, broad-spectrum intravenous antibiotics, and temporary stabilization with multiple Kirschner wires. The soft-tissue defect was addressed with staged wound care and coverage using a reverse sural artery fasciocutaneous flap, supplemented with skin grafting. In a subsequent stage, osseous reconstruction of the cuneiform defects was performed using a tricortical iliac crest bone graft.
Conclusion:
At 6 months, all fractures had united, the iliac crest graft had fully incorporated, and the fasciocutaneous flap had survived completely. Functional outcome was satisfactory, with an American Orthopaedic Foot and Ankle Society score of 80/100. This case highlights that urgent debridement, early stable fixation, staged biological reconstruction with a tricortical iliac crest graft, and timely flap coverage can preserve the limb, restore midfoot stability, reduce the risk of amputation, and provide good functional recovery in severe open complex foot trauma with cuneiform bone loss.