Outcome comparison of Lisfranc injuries treated through dorsal plate fixation versus screw fixation

Abstract

OBJECTIVE: The objective of this prospective study was to test whether the treatment of Lisfranc injuries with open reduction and dorsal plate fixation would have the same or better functional outcomes as treatment with standard trans-articular screw fixation. METHODS: Sixty patients with primarily isolated Lisfranc joint injury were treated by open reduction and dorsal plate fixation or standard screw fixation. The patients were followed on average for 31 months. Evaluation was performed with patients' chief complaint, clinical examination, radiography, and AOFAS Midfoot Scale. RESULTS: Thirty two patients were treated with open reduction and dorsal plate fixation, and twenty eight patients were treated with open reduction and screw fixation. After two years follow-up, the mean AOFAS Midfoot score was 83.1 points in the dorsal plate fixation group and 78.5 points in the screw fixation group (p<0.01). Of the dorsal plate fixation group, radiographic analysis revealed anatomic reduction in twenty-nine patients (90.6%, 29/32) and nonanatomic reduction in three patients. Of the screw fixation group, radiographic analysis revealed anatomic reduction in twenty-three patients and nonanatomic reduction in five patients (82.1%, 23/28). CONCLUSIONS: Open reduction and dorsal plate fixation for a dislocated Lisfranc injury do have better short and median term outcome and a lower reoperation rate than standard screw ORIF. In our experience, we recommend using dorsal plate in ORIF on dislocated Lisfranc injuries. Level of Evidence II, Prospective Comparative Study.

Lisfranc Injuries

“…Advocates for bridge plating propose that avoiding further trauma to the articular surface of the injured joints further limits the risk of posttraumatic arthritis. [44][45][46] More extensive soft tissue dissection is required both at the time of implantation and hardware removal with use of dorsal plates, and more definitive studies are required before their use can be universally supported over screws. The authors typically reserve the use of dorsal locked bridge plating for grade 3 injuries with plantar instability and/or metatarsal base fractures that may limit the degree of stability achieved with transarticular screws (Fig.…”

Partial Extensor Hallucis Longus Injury Following Lisfranc Fixation Loosening

“…These injuries are rare, often misdiagnosed, and can be challenging to manage even for experienced providers [ 1 , 4 - 6 ]. The current preferred treatment of acute unstable Lisfranc injuries is open reduction and internal fixation (ORIF) [ 7 - 8 ]. Primary arthrodesis is also emerging as a promising surgical alternative, particularly in chronic or purely ligamentous injuries.…”

“…Primary arthrodesis is also emerging as a promising surgical alternative, particularly in chronic or purely ligamentous injuries. Currently, the hardware implant that delivers superior outcomes in ORIF is debatable [ 1 , 6 - 7 ].…”

“…Significant damage to the Lisfranc joint is uncommon, with a reported incidence of one per 55,000 individuals, or approximately 0.2% of all orthopaedic traumatic injuries [ 1 , 6 - 7 , 9 ]. The majority of injuries result from high-energy forces, though occasionally they originate from a less traumatic mechanism such as a fall with rotational forces on a hyperplantar-flexed foot [ 10 - 11 ].…”

“…Timely diagnosis and treatment are the foundation of preventing long-term disability. Regrettably, up to 20% of Lisfranc injuries are either misdiagnosed or undiagnosed [ 5 , 7 , 12 ]. In chronic injuries, the compromised joint shifts biomechanical forces, leading to increased metatarsal head pressure, deformation of the metatarsal arch, and secondary degenerative joint disease [ 2 , 9 ].…”