Abstract
BackgroundThe aim of this study was to evaluate the outcome after nondisplaced and stable Lisfranc injuries. Methods26 patients with injuries to the Lisfranc joint complex detected on CT scans, but without displacement were tested to be stable using a fluoroscopic stress test. The patients were immobilized in a non-weightbearing short leg cast for 6 weeks. The final follow-up was 55 (IQR 53–60) months after injury. ResultsAll the Lisfranc injuries were confirmed to be stable on follow-up weightbearing radiographs at a minimum of 3 months after injury. Median American Foot and Ankle Society (AOFAS) midfoot score at 1-year follow-up was 89 (IQR 84–97) and at final follow-up 100 (IQR 90–100); The AOFAS score continued to improve after 1-year (P=.005). The median visual analog scale (VAS) for pain was 0 (IQR 0–0) at the final follow-up. One patient had radiological signs of osteoarthritis at 1-year follow-up. ConclusionStable Lisfranc injuries treated nonoperatively had an excellent outcome in this study with a median follow-up of 55 months. The AOFAS score continued to improve after 1 year.
Highlights
The Lisfranc joint complex comprise of the tarsometatarsal, intercuneiform and naviculocuneiform joints with their associated ligaments [1,2]
The increase in reported incidence seems to be related to an increased awareness of this entity, together with more advanced diagnostic tools such as CT scan, MRI, weightbearing radiographs and fluoroscopic stress test [7,8,10]
A stable Lisfranc injury has been defined as an injury to the Lisfranc joint complex with displacement < 2 mm on weightbearing radiographs and/or no obvious displacement on stress fluoroscopy, when
Summary
The Lisfranc joint complex comprise of the tarsometatarsal, intercuneiform and naviculocuneiform joints with their associated ligaments [1,2]. For stable Lisfranc injuries nonoperative treatment is recommended, only few studies with small patient numbers exist [5,19,20]. Only one study verifies stability by obtaining follow-up weightbearing radiographs, and none have routinely obtained CT scans to rule out minor displacements [19,21]. Methods: 26 patients with injuries to the Lisfranc joint complex detected on CT scans, but without displacement were tested to be stable using a fluoroscopic stress test. Results: All the Lisfranc injuries were confirmed to be stable on follow-up weightbearing radiographs at a minimum of 3 months after injury. Conclusion: Stable Lisfranc injuries treated nonoperatively had an excellent outcome in this study with a median follow-up of 55 months.
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