Advertisement

CT and Functional Outcomes of Primarily Ligamentous and Combined Ligamentous-Bony Lisfranc Injuries: A Retrospective Review

Published:August 26, 2022DOI:https://doi.org/10.1053/j.jfas.2022.08.008

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Calder JD
        • Whitehouse S
        • Saxby T
        Results of isolated Lisfranc injuries and the effect of compensation claims.
        J Bone Joint Surg Br. 2004; 86: 527-530
        • Stødle AH
        • Hvaal KH
        • Enger M
        • Brøgger H
        • Madsen JE
        • Husebye EE
        Lisfranc injuries: incidence, mechanisms of injury and predictors of instability.
        Foot Ankle Surg. 2020; 26: 535-540
        • Ponkilainen VT
        • Laine H-J
        • Mäenpää HM
        • Mattila VM
        • Haapasalo HH
        Incidence and characteristics of midfoot injuries.
        Foot Ankle Int. 2019; 40: 105-112
        • Myerson MS
        • Fisher RT
        • Burgess AR
        • Kenzora JE
        Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment.
        Foot Ankle. 1986; 6: 225-242
        • Sherief TI
        • Mucci B
        • Greiss M
        Lisfranc injury: how frequently does it get missed? And how can we improve?.
        Injury. 2007; 38: 856-860
        • Goossens M
        • De Stoop N
        Lisfranc’s fracture-dislocations: etiology, radiology, and results of treatment. A review of 20 cases.
        Clin Orthop Relat Res. 1983; 176: 154-162
        • Schepers T
        • Oprel PP
        • Van Lieshout EM
        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
        • Perugia D
        • Basile A
        • Battaglia A
        • Stopponi M
        • Minniti De Simeonibus AU
        Fracture dislocations of Lisfranc's joint treated with closed reduction and percutaneous fixation.
        Int Orthop. 2003; 27: 30-35
        • Mulier T
        • Reynders P
        • Dereymaeker G
        • Broos P
        Severe Lisfrancs injuries: primary arthrodesis or ORIF?.
        Foot Ankle Int. 2002; 23: 902-905
        • Henning JA
        • Jones CB
        • Sietsema DL
        • Bohay DR
        • Anderson JG
        Open reduction internal fixation versus primary arthrodesis for Lisfranc injuries: a prospective randomized study.
        Foot Ankle Int. 2009; 30: 913-922
        • Swiontkowski MF
        • Engelberg R
        • Martin DP
        • Agel J
        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
        • Stein RE
        Radiological aspects of the tarsometatarsal joints.
        Foot Ankle. 1983; 3: 286-289
        • Kellgren JH
        • Lawrence J
        Radiological assessment of osteo-arthrosis.
        Ann Rheum Dis. 1957; 16: 494
        • Ly TV
        • Coetzee JC
        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
        • Kuo R
        • Tejwani N
        • Digiovanni C
        • Holt S
        • Benirschke S
        • Hansen S
        • Sangeorzan B
        Outcome after open reduction and internal fixation of Lisfranc joint injuries.
        J Bone Joint Surg Am. 2000; 82: 1609
        • Reinhardt KR
        • Oh LS
        • Schottel P
        • Roberts MM
        • Levine D
        Treatment of Lisfranc fracture-dislocations with primary partial arthrodesis.
        Foot Ankle Int. 2012; 33: 50-56
        • Goiney RC
        • Connell D
        • Nichols D
        CT evaluation of tarsometatarsal fracture-dislocation injuries.
        Am J Roentgenol. 1985; 144: 985-990
        • Richter M
        • Wippermann B
        • Krettek C
        • Schratt HE
        • Hufner T
        • Thermann H
        Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results.
        Foot Ankle Int. 2001; 22: 392-398
        • Thompson MC
        • Mormino MA
        Injury to the tarsometatarsal joint complex.
        J Am Acad Orthop Surg. 2003; 11: 260-267
        • Stavlas P
        • Roberts CS
        • Xypnitos FN
        • Giannoudis PV
        The role of reduction and internal fixation of Lisfranc fracture–dislocations: a systematic review of the literature.
        Int Orthop. 2010; 34: 1083-1091
        • Sands AK
        • Grose A
        Lisfranc injuries.
        Injury. 2004; 35: SB71-SB76
        • Myerson M
        The diagnosis and treatment of injury to the tarsometatarsal joint complex.
        J Bone Joint Surg Br. 1999; 81: 756-763
        • Marín-Peña OR
        • Recio FV
        • Gómez TS
        • Garijo RL
        Fourteen years follow up after Lisfranc fracture-dislocation: functional and radiological results.
        Injury. 2012; 43: S79-S82
        • Wilppula E.
        Tarsometatarsal fracture-dislocation: late results in 26 patients.
        Acta Orthop Scand. 1973; 44: 335-345