Outcomes of a Nontraditional Dual Incision Approach for Lisfranc Trauma, Fractures, and Osteoarthritis

Abstract

Background: Numerous surgical approaches and treatments for Lisfranc pathology have been described and vary across physicians and surgical specialties. Many incisions to access the tarsometatarsal (TMT) joint complex have been described including single and dual longitudinal as well as transverse. The aim of this study was to retrospectively review and compare complication and fusion rates in patients with a Lisfranc open reduction and internal fixation or arthrodesis utilizing a nontraditional dual incision approach. Incisions were performed dorsal medial to the first TMT and dorsal along the second interspace just medial to the third TMT. Materials and Methods: The medical records of 1 foot and ankle surgeon were reviewed of patients who underwent Lisfranc surgery utilizing a dual incision approach for both elective and traumatic procedures. The study period encompassed January 2006 through December 2016. Statistical analysis was performed using information collected from chart-review as well as radiograph evaluation to examine predictors of complications and fusion rates. Results: Sixty-eight patients reviewed had the nontraditional dual dorsal incisions, 61 with TMT fusions for arthritis or injury, and 7 open reduction and internal fixation for TMT injuries. In total, 180 joint fusions were performed on the first, second, or third TMTs during arthrodesis. Four of 68 patients were revisions of previously failed fusions. All 68 patients (100%) healed soft tissue without complication. Of the 180 joints that underwent arthrodesis 170 (94.4%) fused successfully. Hardware removal occurred in 10 patients (14.7%) due to discomfort. Conclusions: This nontraditional dual incision dorsal approach for Lisfranc surgery has a low wound healing complication rate, in fact none were reported in this sample size of 68 patients. This approach is reproducible for either traumatic or elective procedures of the Lisfranc complex allowing excellent visualization of the medial and central tarsometatarsal joints while removing risk to the neurovascular structures inherent in the more traditional incisions. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A Novel Operative Approach to the Treatment of Posterior Malleolus Fractures

“…11,12 This dogma has been challenged in recent years, with reviews of the literature showing good reported outcomes for case series using multiple incisions, <7 cm apart, for pilon fractures, calcaneal osteotomies, and LisFranc injuries. [13][14][15] Our hypothesis was that by having a careful attitude toward soft tissue swelling and wound care, we would be able From the *St. James Hospital Dublin, Dublin; and †Midland Regional Hospital Tullamore, Tullamore, Ireland. The authors declare no conflict of interest.…”

“…It has been widely cited for many years that there should be a 7 cm skin bridge between incisions around the foot and ankle, though a review of the literature does not show where this figure was derived from 11,12. This dogma has been challenged in recent years, with reviews of the literature showing good reported outcomes for case series using multiple incisions, <7 cm apart, for pilon fractures, calcaneal osteotomies, and LisFranc injuries 13–15…”