Abstract
OBJECTIVE: The objective of this prospective study was to test whether the treatment of Lisfranc injuries with open reduction and dorsal plate fixation would have the same or better functional outcomes as treatment with standard trans-articular screw fixation. METHODS: Sixty patients with primarily isolated Lisfranc joint injury were treated by open reduction and dorsal plate fixation or standard screw fixation. The patients were followed on average for 31 months. Evaluation was performed with patients' chief complaint, clinical examination, radiography, and AOFAS Midfoot Scale. RESULTS: Thirty two patients were treated with open reduction and dorsal plate fixation, and twenty eight patients were treated with open reduction and screw fixation. After two years follow-up, the mean AOFAS Midfoot score was 83.1 points in the dorsal plate fixation group and 78.5 points in the screw fixation group (p<0.01). Of the dorsal plate fixation group, radiographic analysis revealed anatomic reduction in twenty-nine patients (90.6%, 29/32) and nonanatomic reduction in three patients. Of the screw fixation group, radiographic analysis revealed anatomic reduction in twenty-three patients and nonanatomic reduction in five patients (82.1%, 23/28). CONCLUSIONS: Open reduction and dorsal plate fixation for a dislocated Lisfranc injury do have better short and median term outcome and a lower reoperation rate than standard screw ORIF. In our experience, we recommend using dorsal plate in ORIF on dislocated Lisfranc injuries. Level of Evidence II, Prospective Comparative Study.
Highlights
Ligament injuries and fracture-dislocations (Lisfranc injury) involving the tarsometatarsal (TMT) joints may lead to chronic pain and functional loss because of arthritis, deformity, residual ligamentous instability, and associated soft-tissue injury
After 2 years follow-up the final AOFAS score in dorsal fixation group is higher than screw fixation group (p
As for the dorsal plate fixation group, we have not encountered patient with deep infection which have to remove the implant, and we merely have encountered four patient with necrosis of incision edge and two superficial infection which were cured by oral antibiotic therapy and changing dressings
Summary
Ligament injuries and fracture-dislocations (Lisfranc injury) involving the tarsometatarsal (TMT) joints may lead to chronic pain and functional loss because of arthritis, deformity, residual ligamentous instability, and associated soft-tissue injury. Open reduction using one or two parallel incisions in the dorsum of the foot and small cortical screws application seems to be the preferred method of management for the injuries in the joints of the medial and middle column (first, second and third metatarsals), while K-wires can be used for the stabilization of the lateral column (fourth and fifth metatarsals) in case of instability.
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