Lisfranc Fracture-dislocation Research Articles

Primary arthrodesis for treatment of special types of Lisfranc fracture dislocation

Background Lisfranc fracture dislocation is a devastating trauma affecting usually young active age group, with a high rate of missing or misdiagnosis, resulting in prolonged recovery and significant long-term morbidity. Objective This study describes the indications, contraindications, technique, and results of treating severe Lisfranc fracture dislocation by primary arthrodesis. Patients and methods A prospective study was conducted on 10 patients with closed Lisfranc fracture dislocation, who had been treated at Benha University Hospital and Benha Insurance Hospital between January 2010 and March 2013. Mechanism of injury was high-velocity injury in five patients, fall from a height in four patients, and a hyperplanterflexion foot trauma during descending stairs in one patient. Mean age at time of surgery was 27.7 years (range, 19–38 years). All patients were followed up with a follow-up period of 21.3 months (range, 6–36 months). Results According to the American Orthopedic Foot and Ankle Society scale, the clinical outcome was 81.7 (range, 79–84). Complications met in this study were as follows: three patients had a postoperative Sudeck’s atrophy, one patient developed superficial wound problem, and two patients had forefoot stiffness and difficulties in shoe wearing. Conclusion Open reduction and internal fixation of severe Lisfranc fracture dislocation with screws and primary arthrodesis is the treatment of choice, as these fracture dislocations are known for their affinity for post-traumatic arthritis and subsequent need for a second operation. The level of evidence for this article was case series type IV.

Acute management of high-energy lisfranc injuries: A simple approach

IntroductionThe aims of this study were to (1) describe the use of the K-wire for the initial management of high-energy Lisfranc dislocations or fracture dislocations, (2) to evaluate whether this standalone technique allowed for adequate reduction of these injuries, (3) to evaluate whether reductions were maintained until definitive fixation was performed, (4) and to determine if it contributed to any increase in complications prior to or after definitive fixation. Patients and methodsA retrospective review was performed on all patients who presented with tarsometatarsal injuries from January 2005 through June 2015. Dislocations of the tarso-metatarsal joints were classified as either Type A (total incongruity, homolateral complex), Type B (partial incongruity, homolateral incomplete) or Type C (divergent, total or partial displacement) patterns, with or without associated fractures. For the purposes of this paper, high-energy injuries were defined as patients presenting with either a Type A or Type C (total displacement) dislocations or fracture-dislocation patterns. A total of 176 patients presented with a tarsometatarsal injury. Eighteen patients with divergent or homolateral patterns underwent a staged approach. Fifteen patients were managed exclusively with K-wire fixation. Wound complications, infections or the unexpected need to return to surgery were recorded. ResultsAll patients demonstrated an improved alignment using K-wires. There were no compartment syndromes, vascular insufficiency, complications to the skin associated with traction or manipulation, or pin site infections. At definitive fixation, no patient demonstrated a loss in the alignment that had been obtained at the index procedure or had an unexpected return to surgery. Discussion and conclusionsThis study demonstrates that high-energy Lisfranc injuries are uncommon and that K-wires are a simple and adequate technique that can be used for initial staged approach of these injuries. The use of 2.0mm K-wires were sufficient to obtain and maintain the reduction until definitive fixation has been obtained, without producing any increase risk for complications.

Do columns or sagittal displacement matter in the assessment and management of Lisfranc fracture dislocation? An alternate approach to classification of the Lisfranc injury

AimThe classification of a Lisfranc injury has conventionally been based around Myerson's system. The aims of this study were to review whether a novel classification system based on sagittal displacement of the tarsometatarsal joint and breadth of injury as determined by a columnar theory was associated with functional outcomes and thus had a greater utility. PatientsWe retrospectively reviewed 54 Lisfranc injuries with a minimum follow up of two years at our Level One Trauma Centre. Each fracture was sub-classified based on our novel classification system which assessed for evidence of sagittal displacement and involvement of columns of the midfoot. Our primary outcome measures were the FFI and AOFAS midfoot scores. ResultsInjuries involving all three of the columns of the midfoot were associated with significantly worse functional outcome scores (FFI p=0.004, AOFAS p=0.036). Conversely, sagittal displacement, whether dorsal or plantar, had no significance (FFI p=0.147, AOFAS p=0.312). The best predictor of outcome was the quality of anatomical reduction (FFI p=0.008, AOFAS p=0.02). ConclusionColumn involvement and not sagittal displacement is the most significant factor in considering the severity Lisfranc injury and long term functional outcomes. This classification system has greater clinical utility than those currently proposed.

An old mismanaged Lisfranc injury treated by gradual deformity correction followed by the second-stage internal fixation

The Lisfranc fracture-dislocation of the foot is uncommon and diagnosis is often missed. The Lisfranc joint involves the articulation between medial cuneiform and base of the second metatarsal and is considered a keystone to structural integrity to the midfoot. The articulation has a stabilization effect on longitudinal and transverse arches of the foot. A neglected or untreated injury to the Lisfranc joint can lead to secondary arthritis and significant morbidity and disability. We present a case of a neglected Lisfranc fracture-dislocation in a 28-year-old female patient who presented 3 months after injury. A staged treatment of distraction with an Ilizarov ring fixator followed in the second stage by the removal of ring fixator and internal fixation with K wires was performed. There was complete relief of pain and a good functional outcome at 3 months after treatment.

Dynamic plantar pressure distribution, strength capacity and postural control after Lisfranc fracture-dislocation

Substantial progress has been made in the operative treatment of Lisfranc fractures, however, the prognosis remains poor. We hypothesized that Lisfranc injuries change the postural control and muscle strength of the lower limb. Both are suggested to correlate with the clinical outcome and quality of life.17 consecutive patients suffering from a Lisfranc fracture dislocation were registered, underwent open reduction and internal fixation and were followed-up for 50.5±25.7months (Mean±SDM). Biomechanical analysis of muscle strength capacities, postural control and plantar pressure distribution was assessed >6 month postoperatively. Results were correlated to clinical outcome (AOFAS, FFI, Pain, SF-36).The isokinetic assessment revealed a significant reduction in plantar flexor and dorsal extensor peak torque of the injured limb compared to the uninjured limb. The dorsal extensor peak torque thereby correlated well with clinical outcome. Altered postural control was evident by a significant reduction in unilateral stance time, from which we calculated a strong correlation between stance time and the isokinetic strength measurement. Plantar pressure measurements revealed a significant reduction in peak pressure under the midfoot and of Force-Time Integral beneath the second metatarsal.Sufficient rehabilitation is crucial to the clinical outcome following anatomical open reduction of Lisfranc fracture-dislocation. The present study supports a rehabilitation approach focussing on restoring proprioception and calf muscular strength including isometric exercises of the dorsal extensors.

Lisfranc Injury Imaging and Surgical Management.

The Lisfranc joint is composed of the cuneiform bones and the cuboid and metatarsal bases, united by a synovial capsule and ligamentous complex. Familiarity with the anatomy is essential for image planning and for understanding injury patterns. The more important structures are the Lisfranc ligament and the plantar ligaments that can be visualized with MR, although careful attention to technique and orientation of scan planes is required for accuracy. A combination of conventional radiographs, computed tomography, and MR allow precise diagnosis of Lisfranc fractures, fracture dislocation, and subtle Lisfranc injuries to guide clinical management and surgical planning.

Functional Outcomes After Temporary Bridging With Locking Plates in Lisfranc Injuries

The standard operative treatment of Lisfranc fracture dislocations currently consists of open reduction and transarticular fixation. Recently, bridge plating has been used more often. Using joint spanning, the reduced fracture dislocation is temporary stabilized to minimize articular damage. The present study describes the outcomes of patients treated with bridge plating after tarsometatarsal fracture dislocations compared with transarticular screw fixation. A retrospective cohort study was performed. Patients with an isolated tarsometatarsal injury who had been treated operatively from June 2000 to October 2013 were included. The primary functional outcome was measured using the American Orthopaedic Foot and Ankle Society midfoot score and the Foot Function Index. The secondary outcome was patient satisfaction, which was measured using the EuroQol 5 dimensions questionnaire and a visual analog scale. A total of 34 patients were included. Bridge plating was used in 21 patients. In 13 patients, Kirschner wires or transarticular screws or a combination were used. The median follow-up period was 49 (interquartile range 18 to 89) months. The implants were removed in 10 of 13 patients in the transarticular group and 17 of 21 patients in the bridge plating group. The incidence of wound complications was comparable in both groups. The median American Orthopaedic Foot and Ankle Society score was lower in the transarticular group (77 versus 66). The Foot Function Index score was 18 in both groups. Patient satisfaction was 90% in the bridge plating group and 80% in the transarticular group. Bridge plating for Lisfranc injuries led to at least similar results compared with transarticular fixation in terms of functional outcomes and patient satisfaction. Longer follow-up is necessary to determine whether the prevention of secondary damage to the articular surface leads to less post-traumatic arthritis and better functional outcomes.

Plates, Screws, or Combination? Radiologic Outcomes After Lisfranc Fracture Dislocation

Traditionally, Lisfranc fracture dislocations have been treated with transarticular screw fixation. A more recent development has been the use of dorsal bridging plates. The aim of the present study was to compare the radiologic outcomes for these 2 methods. Currently, no data comparing the outcomes of these 2 treatment options have been reported. A total of 62 patients were treated for Lisfranc fracture dislocations during a 6-year period. The inclusion criteria included ≥6 months of follow-up data available. Each fracture was classified using the Hardcastle classification system. Each fracture was also allocated into 1 of 4 groups: transarticular screw fixation, dorsal plating, a combination of plate and screw fixation, and nonoperative management. The outcome measures included the Kellgren-Lawrence grading of osteoarthritis and the Wilppula classification of anatomic reduction. In terms of results, radiologic osteoarthritis is not associated with the type of injury according to the Hardcastle classification nor with having an open or closed fracture. The Hardcastle classification is not associated with the type of fixation used. Fractures fixed with a combination of plates and screws had a 3.01 (95% confidence interval 1.036 to 8.74) increased risk of having stage 3 or 4 radiologic osteoarthritis compared with being fixed solely with bridging plates (p = .009). Multivariate analysis revealed that this increased risk of osteoarthritis was dependent on the quality of reduction, with good reductions having a 18.2 (95% confidence interval 15.9 to 21.8) times decreased risk of severe osteoarthritis compared with fair or poor reductions, independent of the type of fixation used (p < .0001). No radiologic benefits were found when comparing plate or screw fixation for Lisfranc fracture dislocations (although screw fixation might be associated with a less planus foot and fewer complications). Instead, a good anatomic reduction was the only predictor of the radiologic outcome, and the Hardcastle classification of fractures did not predict the surgery type or radiologic outcome. Finally, treatment with combination plates and screws resulted in worse radiologic outcomes, possibly owing to more complex fracture patterns.

Arthroscopic Lysis of Arthrofibrosis of the Fifth Tarsometatarsal Joint

Loss of motion of the fifth tarsometatarsal joint can be a cause of lateral foot pain after Lisfranc fracture-dislocation or fracture of the fifth metatarsal tubercle. Arthroscopic lysis of the joint can be an effective surgical treatment with the advantage of minimal soft-tissue trauma and early vigorous mobilization of the joint. The lysis can be extended to the fourth tarsometatarsal joint and the adjacent tendons if indicated.

Midterm functional outcome after operative management of midfoot injuries.

Background. Injuries of the midfoot are often missed and therefore underestimated. Early diagnosis and treatment are crucial for the final outcome. The primary aim of this study was to assess the pattern and results of early operative management of mid-foot injuries after a midterm follow up. Material and methods. This study was conducted on 25 patients (19 Males, 6 Females ) with mean age of 34.6 years (range 18-60 years) with mid-foot fracture dislocations who were admitted consecutively at our centre from May 2008 through November 2010. 25 patients fulfilling our inclusion criteria with mid-foot fracture dislocations were included in this study. Mechanism of injury, its pattern and results of operative management of midfoot injuries were assessed after acute management of these fractures on urgent basis. Evaluation of results was done by AOFAS Score. Results. Most common mode of injury was indirect trauma due to fall (n=12) followed by road traffic accident (n=9). Males (n=19) outnumbered females (n=6). The pattern of injuries requiring operative treatment as per our criteria were Lisfranc fracture dislocations (n=22) and navicular fractures (n=3). The mean follow up was 3.2 years and mean AOFAS score at 3.2 years was 78.36, with most patients losing points to pain and decreased recreational function. Conclusion. The Lisfranc fracture dislocations are the most common injuries around midfoot requiring operative treatment, and we believe that operative treatment considerably improves functional outcome in these injuries.

Bone scintigraphy in the diagnosis of Lisfranc fracture

Background: Lisfranc injuries are uncommon and difficult to diagnose. These injuries have a high potential for causing substantial disability related to post-traumatic osteoarthritis and should be managed early to avoid such complications. Lisfranc injuries are frequently missed on radiographs. Hence, bone scanning may be a useful modality in the diagnosis of Lisfranc fracture. Objectives: To investigate the utility of bone scintigraphy in the diagnosis of undiagnosed cases of Lisfranc fracture. Materials and Methods: We studied 13 cases of Lisfranc fracture (8 females and 5males), that were not diagnosed on plain X-ray. Three-phase bone scintigraphy was performed for each patient after administration of 20 mCi (740 MBq) of Tc-99m MDP using a dual-head gamma camera, interfaced with computer. Flow, blood pool and delayed imaging of the feet were performed for each patient, as well as whole body blood pool and delayed images. Results: All the bone scintigraphic studies of the patients showed hyperemia of the affected foot in flow and blood pool studies and focal area of increased uptake at the mid foot region, particularly the tarsometatarsal joint, in the delayed images typical of Lisfranc fracture. However, X-ray of affected foot previously obtained were available in 11 patients and were normal in 10 patients, while suspicious reflex sympathetic dystrophy was seen in one. Conclusion: Hence, it is essential to be highly aware of the entity of Lisfranc fracture-dislocation when evaluating patients who have mid foot pain, swelling, and its scintigraphic pattern. Because bone scintigraphy is, a useful modality in diagnosing Lisfranc fracture we recommend that it should be more utilized when X-ray is not diagnostic.

Lisfranc dislocation fracture: Dynamic examination under anesthesia and minimally invasive stabilization with mini-TightRope®

As Lisfranc joint injuries are rare and standard radiographic examinations can be difficult to interpret the correct diagnosis is often initially overlooked. Delayed treatment frequently results in painful and disabling arthritis, consequently, primary targeted diagnostics are essential for the functional outcome. We report on a patient with a Lisfranc fracture dislocation, with the injury severity only becoming obvious by dynamic examination with the patient under anesthesia. Due to the massive swelling we performed a minimally invasive primary stabilization using one K-wire and a mini-TightRope®.

Management of Lisfranc fracture dislocation: A series of 11 cases

Management of Lisfranc fracture dislocation: A series of 11 cases

Analysis of Clinical Outcome and Prognosis for Lisfranc Joint Fracture and Dislocation according to the Injury Mechanism and Treatment Method

Purpose: The purpose of this study was to assess the treatment outcomes and prognosis of Lisfranc joint fracture and dislocation according to the mechanism of injury and treatment method. Materials and Methods: Twenty six patients with Lisfranc fracture-dislocation who had been treated surgically were included in this retrospective study. The patients were divided into two groups according to mechanism of injury: direct crushing injury (16 patients) and indirect rotational or compressive injury (10 patients). The patients were also divided into three groups according to the surgical methods. The parameters used were radiographic evaluation, patients’ subjective satisfaction levels, length of hospital stay, and the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score. Statistical analysis was performed. Results: The mean postoperative AOFAS midfoot score was 78.7. The mean length of stay was 39.6 days. Statistically significant differences in subjective satisfaction, AOFAS midfoot score, and length of hospital stay were observed between the two groups (p 0.05). Conclusion: Mechanism of trauma and the severity of soft-tissue injury were significant prognostic factors affecting the surgical outcomes of Lisfranc joint fracture and dislocation.

The effect of the Tscherne injury pattern on the outcome of operatively treated Lisfranc fracture dislocations

Lisfranc fracture dislocations cause severe tarso-metatarsal malalignment. The research question of this study was to evaluate the severity of the soft tissue injury on the final clinical outcome and compare that with the effect of various determinants on the disability in daily living activities after open reduction and internal fixation of a Lisfranc injury. This study consisted of a retrospective analysis of patients with Lisfranc fracture dislocations who were treated by open reduction and internal fixation beween 2004 and 2009. Evaluation focused mainly on the severity of the soft tissue injury, age, fracture classification, time to operation, posttraumatic osteoarthritis, and the results were compared with American Foot and Ankle Society (AOFAS) scores, and Foot and Ankle Disability Index (FADI). Eight patients had Tscherne Grade 1, 13 had Grade 2, and 11 had Grade 3 soft tissue injuries. Myerson classification revealed 11 type A, 8 type B and 13 type C fractures. Six patients' operations were delayed beyond 8h. Of the 38 patients treated in the study period, 32 patients (11 female, 21 male; <30 y-old: 14, >30 y-old: 18) were available for complete follow-up (average, 55.5 months). The comparison of treatment results revealed that those patients with high grade soft tissue injuries had lower AOFAS and FADI scores (43.8±15.9, 53.7±9.4, respectively) when compared to Tscherne Grade 1 injuries (82.8±6.1, 109±13.9, respectively) (p<0.001). The overall negative impact of the severity of soft tissue injury on functional outcomes had similar significance with regard to post-traumatic osteoarthritis, and fracture type. There was also a statistically significant difference between outcome measures and post-reduction quality (p=0.002). Patient age (p=0.9) and delayed surgery (p=0.5) had no statistically significant effect on the final outcome. Satisfactory results can be achieved with open reduction for Lisfranc injuries. However, despite this treatment, both the severity of the soft tissue injury and non-anatomic reduction are negative prognostic factors in the treatment of Lisfranc fracture dislocations.

Early Weight-Bearing After Percutaneous Reduction and Screw Fixation for Low-Energy Lisfranc Injury

Anatomic restoration and postoperative rehabilitation of displaced fracture-dislocations of the tarsometatarsal junction of the foot are essential. Our objective was to report percutaneous reduction and screw fixation results in low-energy Lisfranc fracture dislocation injuries that were treated with early weight-bearing and rehabilitation. We retrospectively evaluated patients with low-energy Lisfranc injuries who underwent surgery between May 2007 and April 2011. The study reviewed 22 patients (12 men and 10 women) with an average age of 36.2 years (range, 16-50 years) and an average follow-up of 33.2 months (range, 12-50 months). We report the mechanism of trauma; quality of reduction in the postoperative digital radiographs; subjective satisfaction; AOFAS score; time required to return to work, recreational activities, and low-impact sports; and complications. Postoperatively, all of the patients were instructed to be non-weight-bearing for 3 weeks, and the stitches were removed after 2 weeks. At the third postoperative week, the patients were encouraged to bear weight as tolerated. Quality of reduction was anatomic or near anatomic in 100% of cases. The subjective satisfaction reported by patients was very good, with complete satisfaction in 20 of them (90.9%). The AOFAS average was 94 points (range, 90-100 points). Average return to work was at 7 weeks (range, 6-9 weeks), recreational activities 7.2 weeks (range, 6-9 weeks), training for low-impact sports 7.6 weeks (range, 7-8 weeks), and symptom-free sport activities 12.4 weeks (range, 11-13 weeks). In this selected group of patients with low-energy Lisfranc fracture dislocation, anatomic or near-anatomic reduction can be achieved with percutaneous reduction and screw fixation. Early weight-bearing is possible in these patients, and early return to regular activities and low-impact sport can be expected. Level IV, retrospective case series.

Influence of Approach and Implant on Reduction Accuracy and Stability in Lisfranc Fracture-Dislocation at the Tarsometatarsal Joint

Besides early diagnosis, an anatomical and stable reduction is paramount for obtaining a favorable outcome. The current study looked at the influence that the type of approach for tarsometatarsal injuries has on the accuracy of the reduction and the effect that the type of fixation has on stability. Consecutive patients treated surgically for an acute Lisfranc injury were included. All radiographs were reassessed for accuracy and secondary displacement following either a closed or an open approach and in terms of the type of fixation (Kirschner wires alone or a combination of screws and plates and Kirschner wires). A total of 28 patients were included. Six patients were treated with closed reduction and percutaneous fixation and 22 with open reduction internal fixation. Sixteen patients were treated with Kirschner wires only (6 closed, 10 open), 7 with screws with or without Kirschner wires, and 5 with medial plating with or without Kirschner wires. In the closed reduction group, 2 of 6 (33%) reductions were considered acceptable versus 19 of 22 (86%) in the open group (P = .021). All 6 secondary displacements occurred in the Kirschner wire fixation group (37.5%) versus none in the rigid fixation group (P = .024). The results demonstrate that open reduction and internal fixation with screws or plate resulted in better reduction and better maintenance of reduction in both low- and high-energy Lisfranc injuries. These results should be further evaluated in light of functional outcome. Level III, retrospective comparative case series.

Closed Reduction &amp; Percutaneous Fixation of Lisfranc Joints Injuries: Possibility, Technique &amp; Results

Introduction: Lisfranc joint injuries are the most common injuries of the midfoot. Injuries include (1) pure Lisfranc joint dislocations, (2) Lisfranc joint fracture dislocations, (3) combined Chopart-Lisfranc joint fracture dislocations, (4) complex Lisfranc joint fracture dislocations with entrapped tibialis anterior tendon and (5) segmental Lisfranc fracture dislocation with concomitant fracture metatarsal neck or head or dislocation of metatarsophalangeal joints. Treatment options vary from closed or open reduction followed by K. wires, screws or plate fixation or primary arthrodesis. Material and Methods: 35 patients with 37 cases of Lisfranc’s joint injuries were treated in Al-Razi orthopedic hospital, Kuwait during the period from January 2006 to December 2010. Injuries were classified using Hardcastle classification. Closed reduction was tried first followed by percutaneous fixation with cannulated 3.5 mm screws for medial 3 joints & K wire fixation for lateral (4th & 5th) TMT joints. Closed reduction was failed in 5 cases and open reduction was performed. Results: Functional results were assessed clinically using AOFAS Midfoot rating scale. The mean follow up period was 24 to 48 months (mean, 38 months). Excellent results were obtained in 15 cases 40.5%; results were good in 15 cases 46%; % fair results obtained in 3 cases 8% and poor results in 2 cases 5.5%. Conclusion: The associated soft tissue injury with Lisfranc joint injury may interfere with surgical treatment of the injury increasing the risk of wound complications like wound dehiscence and deep infection. Early diagnosis of Lisfranc joint injuries allows closed or percutaneous reduction and fixation before massive soft tissue swelling. This minimally invasive treatment decreases the complication rate and allow early rehabilitation compared with the traditional method of open reduction. However open reduction is indicated in cases of complex Lisfranc injury with entrapped tibialis anterior tendon and in combined injury of Lisfranc joint with Chopart or metatarsophalangeal joints to avoid worse results associated with closed or percutaneous reduction in these types of injuries.

Fourteen years follow up after Lisfranc fracture-dislocation: functional and radiological results

Injuries to the Lisfranc joint have a high potential for chronic disability. Posttraumatic arthritis remains the most common complication but not all patients who develop degenerative radiographic changes are symptomatic. A cohort of 32 patients with a Lisfranc fracture dislocation was reviewed. Initial reduction and secondary displacement were measured by the Myerson scale. Radiographic evidence of osteoarthritis (OA) was also investigated. Long-term radiographical data were classified as good, fair or poor results. Functional outcome was measured using several different scales. Mean follow up was 14 years. Seventeen patients with anatomic close reduction but instability were treated with closed reduction and K-wire fixation followed by cast immobilisation. Eight patients with stable anatomic close reduction were treated with closed reduction and cast. Seven patients with unacceptable closed reduction were treated with open reduction and K-wire stabilisation. The analysis of radiological long-term data showed 15 patients with good results, 8 with fair results and 9 with poor results. Final mean AOFAS score was 91.7/100. There was no statistically significant difference between overall PFS scores and different type of treatment, Hardcastle long-term radiological scores or Hardcastle type of fracture (p >0.05).Overall, there was a poor association between the extent of radiological arthritis and clinical scores. We advocate that for the evaluation of long-term outcome of these injuries functional parameters should be the focus of assessment, instead of radiological changes.

Open reduction and internal fixation compared with primary arthrodesis of Lisfranc injuries

Background Lisfranc fracture dislocations occur in approximately 0.1-0.9% of all fractures and are associated with long-term complications, including osteoarthritis and painful deformity. Our aim was to evaluate the best available evidence to assist in guiding clinical decision-making for open reduction and internal fixation compared with primary arthrodesis for acute Lisfranc injuries. Methods We systematically reviewed the effect of alternative methods of management of Lisfranc fractures on validated functional outcome scores and secondary outcomes of further surgery and pain. We identified 147 citations: 12 from MEDLINE, 135 from EMBASE and none from the Cochrane Central Register of Controlled Trials. Only three studies proved eligible. The authors graded and extracted the relevant data. Results All studies compared the treatment of acute Lisfranc fractures by primary arthrodesis with open reduction and internal fixation. All three studies were comparative studies of the two treatment modalities. Two studies were randomized. The relative merits of open reduction and internal fixation compared with primary arthrodesis in the treatment of Lisfranc injuries remains uncertain. The current evidence is mixed. One study reviewed patients with primarily ligamentous injuries and suggested that primary fusion of Lisfranc fractures does improve the functional outcome, whereas the most recent study, assessing osseous and ligamentous injuries, did not show this effect. Both studies, however, did show that secondary surgery was higher in the open reduction and internal fixation groups. Conclusions Given the current level of evidence, further studies, preferably randomized controlled prospective trials, are required to fully ascertain the most favorable management method for these complex and debilitating injuries.