Lisfranc Injuries

Abstract

Lisfranc injuries represent a heterogenous group of ligamentous and combined osseous-ligamentous injuries to the tarsometatarsal/midtarsal articulations. Higher-energy Lisfranc injuries rarely present delayed. Operative treatments have included percutaneous reduction internal fixation, open reduction internal fixation, and primary arthrodesis (PA). Outcomes in higher-energy injuries can be poor and salvage by secondary arthrodesis, if not performed as primary treatment, remains an option. Subtle, lower-energy injuries, or purely ligamentous Lisfranc injuries may be commonly overlooked. These injuries frequently require multiple imaging modalities to fully define, and optimal treatment continues to be controversial. It is universally agreed that regardless of surgical treatment, anatomic reduction of the affected joints is critical to maximize function and minimize pain. One prospective randomized controlled trial supports PA for ligamentous Lisfranc injuries and 1 retrospective comparative study reported PA results similarly favorable in both ligamentous and combined osseous-ligamentous injuries. One prospective randomized controlled trial and all other retrospective comparative studies and meta-analyses concluded that PA is not superior to open reduction internal fixation for ligamentous or combined injuries. Arthrodesis remains a successful option for failed prior nonarthrodesis treatments.Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.