Symptomatic tarsometatarsal osteoarthritis after open reduction and screwing of Lisfranc injuries

Abstract

Objective To explore the outcomes of open reduction and internal fixation (ORIF) with transarticular screws for Lisfranc injuries and the postoperative incidence of symptomatic tarsometatarsal osteoarthritis (OA). Methods This retrospective study involved 28 patients who had been treated surgically at our institution between January 2009 and January 2015 for Lisfranc injuries. They were 18 males and 10 females, with an average age of 36.1 years (from 19 to 54 years). According to the Quenu-Kuss classification, 5 patients had type-A injury, 10 type-B injury (4 cases of type-B1 and 6 ones of type-B2), and 13 type-C injury (8 cases of type-C1 and 5 ones of type-C2). The patients underwent ORIF with screws for the 1st to the 3rd tarsometatarsal joints and ORIF with Kirschner wires for the 4th to the 5th tarsometatarsal joints within 2 weeks. After the Kirschner wires were removed 8 to 10 weeks postoperatively, progressive weight-bearing began. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scores and visual analog scale (VAS) at final follow-ups. Results The mean duration of follow-up was 29.9 months (from 26 to 72 months). AOFAS scores revealed one excellent case, 22 good ones and 5 poor ones with an excellent to good rate of 82.1%. The mean VAS score was 2.8. Radiographic evidence of OA was noted in 20 patients (71.4%, 20/28), in 18 of whom (90.0%) symptomatic OA was observed. There was no significant difference (P=0.399) in the incidence of symptomatic OA either between the patients with anatomic reduction (60.9%, 14/23) and those without anatomical reduction (80.0%, 4/5). Conclusions ORIF with transarticular screws can lead to good therapeutic outcomes for Lisfranc injuries. The incidence of symptomatic OA may not be related to the injury type or reduction quality. Key words: Foot injuries; Bone nails; Osteoarthritis; Open reduction