Staged management of missed lisfranc injuries: A report of short-term results

Abstract

Objective To analyze the clinical and radiographic outcomes of staged reduction and fixation in a consecutive series of patients with the old Lisfranc injuries. Methods Fifty patients (16 feet) with Lisfranc injuries were treated with staged reduction. Mean duration between injury and surgery was 4.8month (3 to 8 month). In first stage an external fixator was applied across the Lisfranc joint and distraction was done at 1 milliliter per day to 2 milliliter per day. In the second staged the ORIF (open reduction and internal fixation) was doneand we were able to reduce all the fractures and dislocations. Extra-Articular screws and staple fixation were used for fixation. We compared categorical variables using Fisher’s exact test and continuous variables using paired t-test or Wilcoxon signed-rank test. Results All patients were followed up 1 to 3 years (mean 2.2 years) in the clinic. The visual analogue scale score averaged 3.1 points at the final follow-up, the average AOFAS scores for these patients were 55.8 points (range, 43 to 98 points), with a significant increase than before surgery (P=0.001). The mean duration between two surgeries was 3.2 weeks (range 2.5-4.5 weeks). Anatomic reduction was obtained in all 15 patients. At the last follow-up, 2 patients had lost reduction. Posttraumatic osteoarthritis was observed in 5 patients, and all of them were scheduled for arthrodesis because of persistent pain. Conclusions The study have displayed that staged reduction and Extra-Articular fixation should be considered for old Lisfranc injuries with a good reduction, the firm stability, low risk of intraoperative fracture.The short-term effectiveness is good, but the long-term effectiveness needs further follow-up. Key words: Missed lisfranc injury; Staged management; Extra-articular fixation; Fractures; Treatment outcome; Joint