ABSTRACT
Lisfranc injuries have been rising in incidence and can cause significant and lasting
morbidity. There is no consensus on the optimal surgical treatment for these injuries,
be they primarily ligamentous or combined (bony and ligamentous). No study has ever
followed Lisfranc injury patients postoperatively using advanced imaging. The purpose
of this study was to compare the functional and radiographic outcomes of primarily
ligamentous and combined osseous and ligamentous Lisfranc injuries treated operatively
with reduction and fixation. We performed a retrospective review of all Lisfranc injuries
treated operatively in a single institution over a 6-year period. Injuries were classified
as primarily ligamentous or combined by independent evaluation of available computed
tomography (CT) or magnetic resonance imaging. Outcomes were measured using the Short
Musculoskeletal Function Assessment (SMFA). CT of 29 patients was performed at last
follow-up to evaluate reduction and degenerative changes. Of the 56 patients identified,
38 were available for follow-up. The average follow-up was 3.8 years. There were 26
combined injuries and 12 primarily ligamentous injuries. Outcomes were excellent in
all patients and there was no statistical difference in SMFA scores in any category
between the groups. On follow-up CT, all injuries were anatomically reduced, and 26
of 29 patients had degenerative changes. Our results support that reduction and stable
fixation of Lisfranc injuries may be suitable treatment regardless of classification
as combined or primarily ligamentous. Future larger-scale prospective studies should
be pursued to supplement existing data.
Level of Clinical Evidence
Keywords
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References
- Results of isolated Lisfranc injuries and the effect of compensation claims.J Bone Joint Surg Br. 2004; 86: 527-530
- Lisfranc injuries: incidence, mechanisms of injury and predictors of instability.Foot Ankle Surg. 2020; 26: 535-540
- Incidence and characteristics of midfoot injuries.Foot Ankle Int. 2019; 40: 105-112
- Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment.Foot Ankle. 1986; 6: 225-242
- Lisfranc injury: how frequently does it get missed? And how can we improve?.Injury. 2007; 38: 856-860
- Lisfranc’s fracture-dislocations: etiology, radiology, and results of treatment. A review of 20 cases.Clin Orthop Relat Res. 1983; 176: 154-162
- Influence of approach and implant on reduction accuracy and stability in Lisfranc fracture-dislocation at the tarsometatarsal joint.Foot Ankle Int. 2013; 34: 705-710
- Fracture dislocations of Lisfranc's joint treated with closed reduction and percutaneous fixation.Int Orthop. 2003; 27: 30-35
- Severe Lisfrancs injuries: primary arthrodesis or ORIF?.Foot Ankle Int. 2002; 23: 902-905
- Open reduction internal fixation versus primary arthrodesis for Lisfranc injuries: a prospective randomized study.Foot Ankle Int. 2009; 30: 913-922
- Short musculoskeletal function assessment questionnaire: validity, reliability, and responsiveness.J Bone Joint Surg Am. 1999; 81: 1245-1260https://doi.org/10.2106/00004623-199909000-00006
- Radiological aspects of the tarsometatarsal joints.Foot Ankle. 1983; 3: 286-289
- Radiological assessment of osteo-arthrosis.Ann Rheum Dis. 1957; 16: 494
- Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation: a prospective, randomized study.J Bone Joint Surg Am. 2006; 88: 514-520
- Outcome after open reduction and internal fixation of Lisfranc joint injuries.J Bone Joint Surg Am. 2000; 82: 1609
- Treatment of Lisfranc fracture-dislocations with primary partial arthrodesis.Foot Ankle Int. 2012; 33: 50-56
- CT evaluation of tarsometatarsal fracture-dislocation injuries.Am J Roentgenol. 1985; 144: 985-990
- Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results.Foot Ankle Int. 2001; 22: 392-398
- Injury to the tarsometatarsal joint complex.J Am Acad Orthop Surg. 2003; 11: 260-267
- The role of reduction and internal fixation of Lisfranc fracture–dislocations: a systematic review of the literature.Int Orthop. 2010; 34: 1083-1091
- Lisfranc injuries.Injury. 2004; 35: SB71-SB76
- The diagnosis and treatment of injury to the tarsometatarsal joint complex.J Bone Joint Surg Br. 1999; 81: 756-763
- Fourteen years follow up after Lisfranc fracture-dislocation: functional and radiological results.Injury. 2012; 43: S79-S82
- Tarsometatarsal fracture-dislocation: late results in 26 patients.Acta Orthop Scand. 1973; 44: 335-345
Article info
Publication history
Published online: August 26, 2022
Footnotes
Financial Disclosure: CT imaging was funded by the Institutional Research Fund. No industry funding was used.
Conflict of Interest: None declared.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American College of Foot and Ankle Surgeons.
