Outcomes after nonoperatively treated non-displaced Lisfranc injury: a retrospective case series of 55 patients

Ville T. Ponkilainen,Ville M. Mattila,Nikke Partio,Heidi H. Haapasalo,Essi E. Salonen,Heikki M. Mäenpää,Heikki-Jussi Laine

doi:10.1007/s00402-020-03599-w

Ville T. Ponkilainen, Ville M. Mattila + Show 5 more

Open Access

https://doi.org/10.1007/s00402-020-03599-w

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Abstract

BackgroundCurrent knowledge of the role of the nonoperative treatment of Lisfranc injuries is based on a few retrospective case series. Hence, consensus on which patients can be treated nonoperatively does not exist. The aim of this study was to investigate outcomes after nonoperative treatment of Lisfranc injuries.MethodsIn this study, patients were collected by recruiting all computer tomography-confirmed Lisfranc injuries treated during a 5-year period at a major trauma hospital. Between 2 and 6 years after suffering the injury, patients completed the visual analogue scale foot and ankle questionnaire.ResultsIn total, 55 patients returned adequately completed questionnaires and were included in the study. Of those, 22 patients had avulsion fractures and 33 had simple non-displaced intra-articular fractures. Of these patients, 30 (55%) scored over 90 points in both the pain and function subscales of the VAS-FA, and 35 (64%) scored over 90 points overall. In addition, three (5%) patients scored under 60 points in both the pain and function subscales of the VAS-FA, and four (7%) scored under 60 points overall. Only one patient with avulsion fractures underwent secondary surgery.ConclusionNonoperative treatment has a role in the treatment of Lisfranc injuries, and the results of our study support the view that avulsion and simple intra-articular fractures with < 2 mm of displacement can be treated nonoperatively with high functional outcomes. The results of nonoperative and operative treatment should be compared in a prospective randomized controlled study setting in future studies.Level of evidenceIV, retrospective case series

Highlights

The ‘Lisfranc injury’ comprises a broad spectrum of tarsometatarsal (TMT) joint injuries that range from subtle injuries to complete dislocation [13, 20, 22, 28]
The main finding of our study is that non-displaced Lisfranc injuries affecting up to three TMT joints can be treated nonoperatively with good functional outcomes
The mean scores for patients without foot pathologies have been reported in the literature as follows: 94.5 for overall, 92.5 for pain, 95.4 for function, and 75.6 for other complaints [8]

Summary

Introduction

The ‘Lisfranc injury’ comprises a broad spectrum of tarsometatarsal (TMT) joint injuries that range from subtle injuries to complete dislocation [13, 20, 22, 28]. Only a few retrospective case series have been published that investigate the nonoperative treatment of Lisfranc injuries. These studies have had several limitations [4, 5, 22, 34]. 22 patients had avulsion fractures and 33 had simple non-displaced intra-articular fractures Of these patients, 30 (55%) scored over 90 points in both the pain and function subscales of the VAS-FA, and 35 (64%) scored over 90 points overall. Conclusion Nonoperative treatment has a role in the treatment of Lisfranc injuries, and the results of our study support the view that avulsion and simple intra-articular fractures with < 2 mm of displacement can be treated nonoperatively with high functional outcomes.

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