Lisfranc??s Fracture-Dislocations

Goossens, Mariëlle E. J. B.; Stoop, Nicky

doi:10.1097/00003086-198306000-00020

Cited by 160 publications

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“…The mechanism of injury is most commonly indirect in nature, imparted by an axial load on a plantarflexed foot. These injuries have also been reported secondary to a direct mechanism by high-energy trauma [2][3][4][5][6] . Lisfranc injuries have a high potential Fig.…”

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confidence: 88%

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Treatment of a Lisfranc Injury in a 7-Year-Old Boy

Kraft

Howard

2022

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Case:This is a case of a 7-year-old boy with a Lisfranc injury identified on weight-bearing films who was treated successfully with closed reduction with a clamp and smooth pin fixation. This patient returned to sports without pain or radiographic signs of arthritis at 1 year.Conclusion:Lisfranc fractures and ligamentous injuries are rare and can occur in skeletally immature children. They have high potential for long-term disability if not properly diagnosed and treated. Although there is no consensus on optimal management of pediatric Lisfranc injuries, restoration of an anatomic Lisfranc joint with smooth pins and immobilization for 6 weeks is a viable treatment option.

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confidence: 88%

“…Lisfranc injuries account for 0.2% of fractures in adults and are even more rare in the pediatric population 2 . There are only a few case series documenting pediatric Lisfranc injuries, with most participants being in the adolescent age range 4,10 .…”

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Treatment of a Lisfranc Injury in a 7-Year-Old Boy

Kraft

Howard

2022

JBJS Case Connector

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“…Prior studies have assessed both operative and nonoperative alternatives to CRPF with suspensory fixation for the treatment of Lisfranc injuries. Nonoperative treatment with closed reduction and cast immobilization of Lisfranc injuries is typically reserved for nondisplaced injuries; however, a number of studies have shown poor outcomes with use of this technique 1-3 . The 2 most common operative alternatives are ORIF and primary arthrodesis 4 .…”

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Closed Reduction and Percutaneous Fixation of Lisfranc Injury Using Suspensory Fixation

Desai

Martin

2023

JBJS Essential Surgical Techniques

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Background:This closed reduction and percutaneous fixation (CRPF) technique utilizing suspensory fixation is indicated for the treatment of Lisfranc injuries with displacement or instability of the tarsometatarsal joint complex—and typically only for low-energy, purely ligamentous Lisfranc injuries. The goal of this procedure is to restore joint stability and prevent common complications of Lisfranc injuries (e.g., midfoot arch collapse and posttraumatic arthritis) while avoiding the complications and risks associated with open reduction and internal fixation (ORIF) and primary arthrodesis. We recommend performing the procedure within 10 to 14 days of the injury; otherwise, an open debridement may be necessary to address scar tissue formation.Description:We start with the patient in the supine position and perform a fluoroscopic stress examination of the joint. Next, the Lisfranc joint undergoes closed reduction, which is held in place with a clamp. Following reduction, a guidewire is drilled from the lateral border of the base of the 2nd metatarsal medially through the medial cuneiform, followed by a medial-to-lateral cannulated drill. The suspensory fixation is then passed lateral-to-medial, placing the suture button on the lateral cortex of the 2nd metatarsal base. The tape is then tensioned while a bioabsorbable interference screw is inserted to maintain tension.Alternatives:Prior studies have assessed both operative and nonoperative alternatives to CRPF with suspensory fixation for the treatment of Lisfranc injuries. Nonoperative treatment with closed reduction and cast immobilization of Lisfranc injuries is typically reserved for nondisplaced injuries; however, a number of studies have shown poor outcomes with use of this technique1-3. The 2 most common operative alternatives are ORIF and primary arthrodesis4.Rationale:CRPF with suspensory fixation offers several benefits over both traditional surgical techniques such as ORIF and primary arthrodesis, as well as over percutaneous reduction and internal fixation (PRIF) with a screw. Compared with ORIF and primary arthrodesis, a number of studies have shown that percutaneous treatment of Lisfranc injuries minimizes soft-tissue trauma and reduces the risk of postoperative complications such as wound breakdown, infection, and complex regional pain syndrome, while allowing for earlier participation in rehabilitation5-10. A systematic review of outcomes following PRIF with screw fixation also showed that percutaneous treatment of Lisfranc injuries is a safe and effective technique with good functional outcomes11. When comparing PRIF with a screw to our technique of CRPF with suspensory fixation, CRPF has the added benefit of creating a nonrigid fixation in the Lisfranc joint, which allows for increased range of motion of the medial column and improved return to activity12,13. The rigid fixation in PRIF with a screw can also lead to metal irritation, intra-articular screw fracture, and impaired mobility, which often necessitate the need for screw removal13-15. This ...

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“…It is suspected that as many as 24% of Lisfranc injuries are overlooked during the initial evaluation, which poses the concern that Lisfranc injuries may occur more frequently than reported. [2][3][4][5] Common complications of an untreated midfoot injury include instability of the joint, malunion, nonunion, and arthritis, all of which may lead to pain and disability. Hence, operative treatment is recommended for patients with displaced fractures and dislocations of the tarsometatarsal (TMT) joint complex.…”

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confidence: 99%

Functional Outcomes of Primary Arthrodesis (PA) Versus Open Reduction and Internal Fixation (ORIF) in the Treatment of Lisfranc Injuries

Aneja

Gal

Dawson

et al. 2023

Journal of Orthopaedic Trauma

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Objectives: To determine whether primary arthrodesis (PA) or open reduction and internal fixation (ORIF) results in better functional outcomes through patient-reported outcome measures (PROMs). Reoperation rates and surgical characteristics among the 2 groups are evaluated as well. Design: A retrospective cohort study. Setting: Level 1 trauma center. Patients: Eighty-one patients treated using PA or ORIF for Lisfranc injuries between January 2010 and January 2019. Main Outcome Measurements: PROMs were collected using the validated Foot and Ankle Ability Measure questionnaire. Follow-up ranged from 1 to 10 years posttreatment. Results: Two hundred patients underwent ORIF, and 72 patients underwent PA. Eighty-one of 272 patients responded to the questionnaire. The Foot and Ankle Ability Measure revealed activities of daily living subscores for PA and ORIF of 69.78 ± 18.61 and 73.53 ± 25.60, respectively (P = 0.48). The Sports subscores for PA (45.81 ± 24.65) and ORIF (56.54 ± 31.13) were not significantly different (P = 0.11). Perceived levels of activities of daily living (P = 0.32) and Sports (P = 0.81) function, compared with preinjury levels, were also not significantly different between the 2 groups. Rates of reoperation were nearly identical for PA (28.1%) and ORIF (30.6%) (P = 1.00). Conclusion: Our results suggest that neither PA nor ORIF is superior regarding functional outcomes or rates of reoperation in the surgical treatment of Lisfranc injuries when appropriately triaged by the treating surgeon. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Lisfranc??s Fracture-Dislocations

Cited by 160 publications

References 0 publications

Treatment of a Lisfranc Injury in a 7-Year-Old Boy

Treatment of a Lisfranc Injury in a 7-Year-Old Boy

Closed Reduction and Percutaneous Fixation of Lisfranc Injury Using Suspensory Fixation

Functional Outcomes of Primary Arthrodesis (PA) Versus Open Reduction and Internal Fixation (ORIF) in the Treatment of Lisfranc Injuries

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