Retrospective analysis of treatment decisions and clinical outcome of Lisfranc injuries: operative vs. conservative treatment

Josefine Graef,Frank Graef,Serafeim Tsitsilonis,Pascal Nadler,Tobias Gehlen,Marcel Niemann

doi:10.1007/s00264-021-05135-w

Abstract

PurposeLisfranc injuries are rare and often pose a challenge for surgeons, particularly in initially missed or neglected cases. The evidence on which subtypes of Lisfranc injuries are suitable for conservative treatment or should undergo surgery is low. The aim of this study was to retrospectively analyze treatment decisions of Lisfranc injuries and the clinical outcome of these patients within the last ten years.MethodsAll patients treated due to a Lisfranc injury in a German level I trauma centre from January 2011 until December 2020 were included in this study. Radiologic images and medical data from the patient files were analyzed concerning the classification of injury, specific radiologic variables, such as the Buehren criteria, patient baseline characteristics, and patient outcome reported with the Foot Function Index (FFI).ResultsNinety-nine patients were included in this study (conservative = 20, operative = 79). The overall clinical outcome assessed by the FFI was good (FFI sum 23.93, SD 24.93); patients that were identified as suitable for conservative treatment did not show inferior functional results. Qualitative radiological factors like the grade of displacement and the trauma mechanism were more strongly associated with the decision for surgical treatment than quantitative radiologic factors such as the distance from the first to the second metatarsal bone.ConclusionIf the indication for conservative or operative treatment of Lisfranc injuries is determined correctly, the clinical outcome can be comparable. These decisions should be based on several factors including quantitative and qualitative radiologic criteria, as well as the trauma mechanism.

Highlights

The Lisfranc joint line is formed by the tarsometatarsal (TMT) joints and its name was given by French surgeon Jacques Lisfranc de Saint-Martin who performed an amputation of the middle foot at the level of this joint line during the
M2-M5 are connected by strong ligaments, which often results in a bony avulsion or rupture of the Lisfranc ligament connecting C1 and M2 (Fig. 1) [2]
Trauma mechanisms leading to an injury of the Lisfranc joint can be subdivided into direct forces on the foot and indirect injuries

Summary

Introduction

The Lisfranc joint line is formed by the tarsometatarsal (TMT) joints and its name was given by French surgeon Jacques Lisfranc de Saint-Martin who performed an amputation of the middle foot at the level of this joint line during the Napoleonic wars [1]. M2-M5 are connected by strong ligaments, which often results in a bony avulsion or rupture of the Lisfranc ligament connecting C1 and M2 (Fig. 1) [2]. Trauma mechanisms leading to an injury of the Lisfranc joint can be subdivided into direct forces (crush injuries) on the foot and indirect injuries (distortion trauma). Indirect injuries can be divided into high-energy trauma (e.g., motor vehicle accidents, fall from height > 3 m) and low-energy trauma (e.g., fall from standing height)

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