Minimally Invasive Medial Plating of Low-Energy Lisfranc Injuries: Preliminary Experience with Five Cases

Abstract

Fracture dislocations involving the Lisfranc joint are rare; they represent only 0.2% of all the fractures. There is no consensus about the surgical management of these lesions in the medical literature. However, both anatomical reduction and tarsometatarsal stabilization are essential for a good outcome. In this clinical study, five consecutive patients with a diagnosis of Lisfranc low-energy lesion were treated with a novel surgical technique characterized by minimal osteosynthesis performed through a minimally invasive approach. According to the radiological criteria established, the joint reduction was anatomical in four patients, almost anatomical in one patient (#4), and nonanatomical in none of the patients. At the final follow-up, the AOFAS score for the midfoot was 96 points (range, 95–100). The mean score according to the VAS (Visual Analog Scale) at the end of the follow-up period was 1.4 points over 10 (range, 0–3). The surgical technique described in this clinical study is characterized by the use of implants with the utilization of a novel approach to reduce joint and soft tissue damage. We performed a closed reduction and minimally invasive stabilization with a bridge plate and a screw after achieving a closed anatomical reduction.

Outcomes After Percutaneous Reduction and Fixation of Low-Energy Lisfranc Injuries

“…However, their follow-up was only 19 months, on average, and the study only included 5 patients. 7 Wagner et al reported on 22 patients with low-energy injuries treated with a percutaneous technique. While their study primarily aimed to evaluate the results of early weightbearing following percutaneous fixation, their patient-reported outcomes demonstrated very good to complete satisfaction with an average AOFAS score of 94 (range, 90-100).…”

“…4,23 In an effort to minimize these soft tissue complications, techniques that minimize iatrogenic soft tissue trauma and dissection, such as fluoroscopically assisted percutaneous techniques, are becoming more commonplace. 5,7…”

Letter Regarding: Biomechanical Comparison of Achilles Tendon Pullout Strength Following Midline Tendon-Splitting and Endoscopic Approaches for Calcaneoplasty

“…Finally, we want to mention that all the coauthors of this letter usually perform minimally invasive procedures 2,4 -6 on a regular clinical basis. Nevertheless, we would like to emphasize that these procedures must continue growing through safe steps and valid information to ensure their persistence in the future.…”

Staged management of open Lisfranc injury

“…However, concern has been raised regarding further articular cartilage damage during the introduction of screws. [ 24 ] Currently, bridging plate fixation is more often used in internal fixation for Lisfranc injury. [ 25 , 26 ] In our study, for patients with metatarsal shaft or base fracture, screw fixation may cause implant failure.…”