Outcome After Open Reduction And Internal Fixation Of Lisfranc Joint Injuries

Objective: Lisfranc injuries account for0.2percent of all fractures.Openreduction and internal fixation has been recommended as the treatment for mostunstable injuries of the Lisfranc (tarsometatarsal) joint. We performed a retrospectivestudy of the outcome after open reduction and internal fixation of lisfranc joint injuries.Methods: We performed a retrospective study of all patients with atarsometatarsal joint injury treated between2010-2and2012-12.All37patientsunderwent open reduction and screw fixation of a Lisfranc injury. Among thirty-sevenadults treated for that injury, thirty-two patients were followed for an average of twelvemonths (range, three to twenty four months).Nine injuries were purely ligamentous, andtwenty three were combined ligamentous and osseous. Patient outcome was assessedwith use of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score.Results: The overall outcomes after surgical treatment of Lisfranc injuries aregood, and usually patients have few limitations.The average AOFAS midfoot score was75.3points (on a scale of0to100points, with100points indicating an excellentoutcome), with patients losing points for mild pain, decreased recreational function, andorthotic requirements. Eleven patients (34percent) had posttraumatic osteoarthritis ofthe tarsometatarsal joints, and four of them required arthrodesis. The major determinantof a good result was anatomical reduction (p=0.05). No significant difference inoutcome scores could be detected when purely ligamentous injuries were comparedwith combined ligamentous and osseous injuries,）open wounds were compared withclosed wounds, involvement of five tarsometatarsal joints was compared withinvolvement of fewer than five, the presence of associated cuneiform and/or cuboidinjury was compared with the absence of either injury, isolated injury was comparedwith multiple injuries, multiple trauma was compared with the absence of multipletrauma, Conclusion：Anatomical reduction and stable internal fixation has become astandard principlegoverning treatment of tarsometatarsal fracture-dislocations. Mostauthors have agreed that stable anatomical reduction leads to optimal results. Our studysupports this concept as patients with anatomical reduction had a significantly betteraverage AOFAS score (p=0.05). Our results support the concept that stable anatomicalreduction of fracture-dislocations of the Lisfranc joint leads to the best outcomes aspatients so treated have less arthritis as well as better AOFAS midfoot scores. Finally,anatomical reduction may be less predictive of a good result in patients who havedislocation without fracture. It may be that injuries involving damage to theligament-bone interface cannot heal with sufficient strength for the patient to regainstable longtermfunction. However, this question would best be answered by aprospective study.