Functional Outcomes of Open Reduction and Internal Fixation Treatment of Lisfranc Injuries

CATEGORY: Midfoot/Forefoot; Sports; Trauma INTRODUCTION/PURPOSE: Prior reports have suggested that primary partial arthrodesis may be superior to open reduction and internal fixation (ORIF) for the ligamentous Lisfranc injury. Although this may be true for the high energy Lisfranc injury, little has been studied regarding outcomes after operative fixation of low energy Lisfranc injuries. The purpose of this study is to present a large case series of patients who underwent ORIF for low energy ligamentous Lisfranc injuries including functional outcomes, complications, and reoperation rates. METHODS: We included adult patients who underwent ORIF for low-energy Lisfranc injuries with fellowship-trained foot and ankle surgeons at our institution within 6 weeks of injury. Patients were excluded if the mechanism of injury or initial radiographs were consistent with a high-energy mechanism such as significant subluxation of multiple tarsometatarsal joints rather than subtle diastasis with weight-bearing images. Patients were also excluded if there were any significant fractures aside from avulsion fractures, other associated injuries, or underlying neuropathic pathophysiology. Patients completed the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales, Visual Analog Scale for Pain (VAS), and Short Form-12 questionnaires before their procedures and then at least 2 years post-operatively. Standard demographic data was collected. Spearman’s correlations and Student’s t-tests were performed to evaluate outcomes after surgery and any relationship between patient characteristics and functional scores. RESULTS: Eighty-seven patients completed functional scores an average of 4.9 years following their procedure (range 2.0 - 8.9), with average age of 41 and average BMI of 27.5. Fifty-two patients (59.8%) were female, and average time from injury to procedure was 15.2 days (range 1-36). Average FAAM-ADL improved from 27.83 to 88.36 postoperatively (p<.001), average FAAM-Sports improved from 7.47 to 76.36 (p<.001), and average VAS pain rating was reduced from 62.83 to 21.78 (p<.001). Hardware removal was performed in 36 cases (41.4%). One patient required removal of hardware and revision ORIF 30 days after the index procedure as a result of hardware complication. Both age at the time of surgery and BMI were negatively correlated with followup SF-12 Physical Health scores (r=-0.254, p=0.018; r=-0.263, p=0.014 respectively). CONCLUSION: This study is one of the largest case series of low energy Lisfranc injuries. We demonstrate that ORIF for low- energy Lisfranc injuries results in significant functional improvement and pain reduction while maintaining low rates of loss of correction or reoperation. Further investigation is necessary to evaluate this subset of Lisfranc injuries in terms of optimal surgical treatment patient functional outcomes following the use of primary arthrodesis in the treatment of Lisfranc procedures, and to assess the efficacy of the various hardware choices available for the procedure.