Complex foot injury along the supination line Classification, surgical management and functional outcome

This thesis explores the classification, surgical management, complications, and functional outcome of complex foot injuries along the supination line. This conceptual line, described by Hellpap (1963) and rooted in earlier observations by Pouteau (1783) and Malgaigne (1847), describes the path along the ankle and foot where supination trauma causes typical injury patterns. These injuries result from lateral traction and medial compression and include over twenty fractures and ligamentous injures. Despite its biomechanical relevance, the supination line remains underrecognized in clinical practice, contributing to missed or delayed diagnoses. In this thesis, seven supination line injuries were studied.
Posterior talar fractures are frequently misdiagnosed and generally benefit from operative treatment, even when minimally displaced, resulting in better outcomes and fewer complications than nonoperative care. Talar head and navicular fractures often occur in combination with other foot injuries. Open reduction and internal fixation (ORIF) typically yields good long-term function when anatomical alignment is restored. Chopart injuries involving both talar head and navicular fractures require attention to both sites for optimal results, although surgical reduction of the talar head does not guarantee better function. Cuboid fractures show favorable outcomes and highpatient satisfaction following ORIF, particularly with plating. For Lisfranc injuries, the CISS classification demonstrated greater reliabilitythan the Myerson system. Dorsal bridge plating resulted in better functional outcome and less arthritis than transarticular screws. Primary arthrodesis showed slightly superior long-term results compared with secondary arthrodesis after failed ORIF. Combined Chopart and Lisfranc injuries remain challenging and associated with high complication rates and poor outcomes.