Outcome of surgically treated Lisfranc injury

NewsBot · Sep 14, 2023

Lisfranc Injury: Recent Trends in Management
Arnab Sain et al
Cureus. 2023 Aug 9;15(8):e43182

Lisfranc injury refers to a group of bony or ligamentous injuries in which one or more of the metatarsals are displaced with respect to the tarsus. These injuries can occur as a result of either high-energy trauma like motor vehicle accidents and falls from height, or low-energy trauma from sports activities. A significant proportion of Lisfranc injuries are missed initially. The effects of delayed and missed diagnosed cases can be devastating as patients may develop progressive midfoot instability, collapse of arch, abduction of forefoot, and post-traumatic osteoarthritis, which can cause chronic pain, stiffness, and foot and ankle complex dysfunction. Favourable outcomes are associated with early diagnosis and prompt treatment. Open reduction and internal fixation (ORIF) with arthrodesis has better results than ORIF alone in functional outcomes. Dorsal bridge plates are currently the preferred mode of fixation due to advantages over trans-articular screws.
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NewsBot · Nov 28, 2023

EFFECTS OF RIGID AND KINESIO TAPING ON PLANTAR PRESSURE DISTRIBUTION IN PATIENTS WITH LISFRANC FRACTURE SEQUELAE
Orhan OZTURK et al
Gait & Posture 28 November 2023

Background
Patients with Lisfranc fractures may regain functional status after anatomical fixation, but they may experience sequelae such as flatfoot deformity and pain associated with foot pressure distribution during weight-bearing.

Research question:
What is the impact of Lisfranc fracture sequelae on both the injured and uninjured sides, and how does the antipronation taping affect plantar pressure distribution parameters?

Methods
Twenty-six patients who underwent anatomical fixation for Lisfranc fracture, displaying pronation on the injured side based on the Foot Posture Index-6 test, as well as 15 healthy subjects, participated in this study. Plantar pressure distribution measurements were conducted during barefoot walking for the healthy subjects. In the patient group, measurements were taken under two antipronation taping conditions (kinesio and rigid taping), as well as during barefoot walking.

Results
Participants who received anatomical fixation after Lisfranc fracture exhibited significant alterations in plantar pressure distribution parameters on both the injured and uninjured sides, as compared to the control group. After the application of Kinesio Taping to the injured side, there was no significant change observed in the plantar pressure distribution values (p > 0.05). The analysis of the rigid taping on the injured side revealed statistically worse values in peak pressure of the hindfoot (p=0.027) and maximum force of the midfoot and toes (p=0.005 and p=0.013, respectively) compared to the injured barefoot condition.

Significance
Lisfranc fracture sequelae affected plantar pressure distribution on both injured and uninjured sides. Anti-pronation taping (kinesio and rigit), commonly used for foot conditions, did not lead to foot pressure distribution becoming more similar to that of the control group.
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NewsBot · Dec 24, 2023

The 5-minute Tightrope: A guide to efficient placement of flexible Lisfranc fixation
Nevin Joseph, DPM et al
Vol. 2 No. 12 (2023): December 2023 / Articles

Ligamentous Lisfranc injuries can be a challenging pathology for foot and ankle surgeons to diagnose and treat. When surgical intervention is warranted, dynamic flexible fixation is a widely used option that continues to popularize. We present a technique guide that can increase efficiency, decrease operative time and decrease fixation malposition when using flexible fixation devices for ligamentous Lisfranc injuries.
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NewsBot · Jan 12, 2024

Effects of rigid and kinesio taping on plantar pressure distribution in patients with Lisfranc fracture sequelae
Orhan Ozturk et al
Gait Posture. 2023 Nov 28

Background: Patients with Lisfranc fractures may regain functional status after anatomical fixation, but they may experience sequelae such as flatfoot deformity and pain associated with foot pressure distribution during weight-bearing.

Research question: What is the impact of Lisfranc fracture sequelae on both the injured and uninjured sides, and how does the antipronation taping affect plantar pressure distribution parameters?

Methods: Twenty-six patients who underwent anatomical fixation for Lisfranc fracture, displaying pronation on the injured side based on the Foot Posture Index-6 test, as well as 15 healthy subjects, participated in this study. Plantar pressure distribution measurements were conducted during barefoot walking for the healthy subjects. In the patient group, measurements were taken under two antipronation taping conditions (kinesio and rigid taping), as well as during barefoot walking.

Results: Participants who received anatomical fixation after Lisfranc fracture exhibited significant alterations in plantar pressure distribution parameters on both the injured and uninjured sides, as compared to the control group. After the application of Kinesio Taping to the injured side, there was no significant change observed in the plantar pressure distribution values (p > 0.05). The analysis of the rigid taping on the injured side revealed statistically worse values in peak pressure of the hindfoot (p = 0.027) and maximum force of the midfoot and toes (p = 0.005 and p = 0.013, respectively) compared to the injured barefoot condition.

Significance: Lisfranc fracture sequelae affected plantar pressure distribution on both injured and uninjured sides. Anti-pronation taping (kinesio and rigit), commonly used for foot conditions, did not lead to foot pressure distribution becoming more similar to that of the control group.
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NewsBot · Jan 12, 2024

Short-term Follow-up of Patients Receiving Bio-integrative Screws for Lisfranc Injuries: A Case Series
Alireza Ebrahimi et al
J Orthop Case Rep. 2023 Dec;13(12):34-39

Introduction: Various methods are used for open reduction and internal fixation of Lisfranc injuries, and each shows different post-treatment outcomes. Other than the common post-surgery problems in these patients, including possible non-anatomical reduction, implant loosening, breakage, and arthritis, most of these patients will undergo a second surgery for implant removal which itself might cause further complications. To reduce the need for re-operation, bio-degradable or bio-integrative implants can be promising; however, the short- and long-term outcomes have been scarcely investigated to date.

Case report: We followed up 10 adult patients who received bio-integrative screws for Lisfranc injuries. The patients were asked to fill out the patient-reported outcome measures (PROMs) surveys during one of the follow-up visits. We gathered variables including the type of injury, pain score, and PROMs including physical function (PF), pain interference, pain intensity, and depression. We evaluated the patients for wound dehiscence, non-union, and hardware failure. The median (interquartile range [IQR]) follow-up time of the patients in this study was 9 (4-11.5) months. Nine out of 10 patients with Lisfranc injuries who received bio-integrative screws showed improvements in their pain scores and started progressive weight-bearing. Among 3 patients who had sport-related Lisfranc injuries, 2 returned to play in <6 months, and one started side-to-side agility work in <3 months. The median (IQR) scores of PROMs representing PF, depression, physical health, mental health, pain interference, and pain intensity were 49.5 (30.1-61.9), 41 (41-49), 50.8 (39.2-57.7), 59 (48.9-63.7), 51.7 (41.6-72.6), and 43.5 (37.8-55.2), respectively.

Conclusion: Our results demonstrated promising short-term outcomes of using bio-integrative screws in patients with Lisfranc injuries based on PROMs and the rate of complications. Future studies on larger populations and more comprehensive variables with longer follow-up duration should be the next step in evaluating the pros and cons of these new implants.
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NewsBot · Feb 22, 2024

Nonunion rate following primary arthrodesis for acute Lisfranc injuries
Nathaniel A Ptak et al
J Foot Ankle Surg. 2024 Feb 10

Injury to the tarsometatarsal joint (TMT) results in instability throughout the midfoot that does not often improve with conservative management. If instability is identified, surgical intervention is frequently recommended, either open reduction and internal fixation (ORIF) or primary arthrodesis (PA). These two treatment options have been compared in the literature multiple times, often reporting similar outcomes. Due to this, as well as the need for subsequent hardware removal after ORIF has led many surgeons towards PA at the index surgery. Concern for nonunion is a leading concern with surgeons who advocate instead for ORIF. The purpose of this study is to review patients who underwent PA and observe nonunion rates. Nonunion at the TMT has been previously studied, but only in the chronic setting. We performed a retrospective study of 34 patients who had PA in the management of an acute Lisfranc injury. The average age in our study was 43.9 years old (range 19-72, SD 17.4) with an average follow-up of 9.4 months (range 4-33, SD 6.2). Radiographs were evaluated for signs of nonunion at regular post-operative intervals. Within the patients included in the study, a total of 71 TMT joints were fused. Overall successful fusion rate was 95.8% at an average of 7.9 weeks (range 6-12, SD 1.4) post operatively. Individual nonunion rates at the first, second, and third TMT were 0%, 1.4% and 2.8% respectively. Our study demonstrates that primary arthrodesis provides a predictable outcome with low nonunion rates in the management of acute Lisfranc injury.
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NewsBot · Jun 18, 2024

Inconsistent radiographic diagnostic criteria for Lisfranc injuries: a systematic
review
Dexter Seow et al
Research Square

Purpose
To evaluate the radiographic diagnostic criteria and propose standardised radiographic criteria for Lisfranc injuries.
Methods
A systematic review of the PubMed and Embase databases was performed according to the PRISMA guidelines. The various radiographic criteria for the
diagnosis of Lisfranc injuries were extracted. Descriptive statistics were presented for all continuous (as mean ± standard deviation) and categorical variables
(as frequencies by percentages).
Results
The literature search included 29 studies that totalled 1115 Lisfranc injuries. The risk of bias ranged from “Low” to “Moderate” risk according to the ROBINS-I
tool. The overall recommendations according to the GRADE assessment ranged from “Very Low” to “High”. 1st metatarsal to 2nd metatarsal diastasis was the
most common of the 12 various radiographic diagnostic criteria observed, as was employed in 18 studies. This was followed by 2nd cuneiform to 2nd
metatarsal subluxation, as was employed in 11 studies.
Conclusion
The radiographic diagnostic criteria of Lisfranc injuries were heterogeneous. The proposition for homogenous radiographic diagnostic criteria is that the
following features must be observed for the diagnosis of Lisfranc injuries: 1st metatarsal to 2nd metatarsal diastasis on anteroposterior view or 2nd
cuneiform to 2nd metatarsal subluxation on anteroposterior or oblique views. Further advanced imaging by CT or MRI may be required in patients with normal
radiographs but with continued suspicion for Lisfranc injuries.
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NewsBot · Jul 17, 2024

Internal Brace Fixation Technique for Lisfranc Injury: A Retrospective Study
Guanglong Zeng et al
Med Sci Monit. 2024 Jul 2

BACKGROUND The Lisfranc ligament is crucial for maintaining the transverse and longitudinal arch of the foot. Owing to the disruption between the medial cuneiform bone and the base of the second metatarsal bone, the currently preferred fixation method remains controversial. Our fixation technique involves screwing one anchor to the medial and intermediate cuneiform bones and using the anchor to carry the ligament to bind the Lisfranc joint and first and second metatarsal joints altogether for elastic fixation. This study evaluated the clinical and functional outcomes of InternalBrace fixation for Lisfranc injury. MATERIAL AND METHODS This retrospective study included 58 patients who underwent InternalBrace fixation for Lisfranc injury between January 2019 and September 2022 by an experienced surgeon. One-way analysis of variance or t test was used. Preoperative classification was performed according to the Myerson classification with imaging data. Postoperative follow-up was performed based on intraoperative blood loss, fracture healing time, visual analog scale (VAS) score, the American Orthopedic Foot and Ankle Society (AOFAS) score, Tegner score, and complications. RESULTS Surgery was completed in all patients, and follow-up was performed. The patients' ages ranged from 19 to 62 years (average: 34.6±9.4 years). The postoperative follow-up time was 12-24 months (average: 16.9±3.0 months). The average time for fracture healing was 12.8±3.0 (10-24) weeks. The VAS, AOFAS, and Tegner scores significantly improved postoperatively (from 5.33±1.0 (3-7) to 1.24±0.57 (0-2); 28.02±6.70 (18-51) to 91.59±4.76 (82-96); and 2.40±0.67 (1-4) to 6.53±0.54 (6-7), respectively), which was statistically significant (P<0.01), and the good rate of AOFAS was 91.4%. The postoperative complications were traumatic arthritis, incision infection, and temporary dorsal foot numbness, which gradually recovered. No other rejection reactions or Lisfranc fracture/dislocations recurrence occurred during the follow-up period. CONCLUSIONS InternalBrace fixation for Lisfranc injury is beneficial for restoring Lisfranc joint stability and function and allows for early and more aggressive rehabilitation for patients, with fewer surgical complications.
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NewsBot · Aug 1, 2024

Weightbearing Computed Tomography Can Accurately Detect Subtle Lisfranc Injury
Rohan Bhimani et al
Foot Ankle Int. 2024 Jul 30

Background: Early detection of Lisfranc injury is critical for improving clinical outcomes, but diagnosing subtle injury can be difficult. Weightbearing computed tomography (WBCT) allows evaluation of such injuries in 3 dimensions (3D) under physiologic load. This study aimed to assess the utility of 1-, 2-, and 3-dimensional measurements on WBCT to diagnose subtle injury in isolated ligamentous Lisfranc injuries.

Methods: Ten cadaveric specimens underwent WBCT evaluation of the Lisfranc joint complex in the intact state and subsequently with sequential sectioning of the dorsal Lisfranc ligament and interosseous Lisfranc ligament (IOL) to create subtle Lisfranc injury, and finally after transectioning of plantar Lisfranc ligament (PLL) to create the injury conditions for complete ligamentous Lisfranc injury. Measurements under static vertical tibial load of 80 kg were performed on WBCT images including (1) Lisfranc joint (medial cuneiform-base of second metatarsal) volume, (2) Lisfranc joint area, (3) C1-C2 intercuneiform area, (4) C1-M2 distance, (5) C1-C2 distance, (6) M1-M2 intermetatarsal distance, (7) first tarsometatarsal (TMT1) alignment, (8) second tarsometatarsal (TMT2) alignment, (9) TMT1 dorsal step-off distance, and (10) TMT2 dorsal step-off distance.

Results: In the subtle Lisfranc injury state, Lisfranc joint volume and area, C1-M2 distance, and M1-M2 distance measurements on WBCT significantly increased, when compared with the intact state (P values .001 to .014). Additionally, Lisfranc joint volume and area, C1-M2 distance, M1-M2 distance, TMT2 alignment, and TMT2 dorsal step-off measurements were increased in the complete Lisfranc injury state. Of all measurements, C1-M2 distance had the largest area under the curve (AUC) of 0.96 (sensitivity = 90%; specificity = 90%), followed by Lisfranc volume (AUC = 0.90; sensitivity = 80%; specificity = 80%) and Lisfranc area (AUC = 0.89; sensitivity = 80%; specificity = 100%).

Conclusion: In a cadaveric model we found that WBCT scan can increase the diagnostic accuracy for subtle Lisfranc injury. Among the measurements, C1-M2 distance exhibited the highest level of accuracy. The 2D joint area and 3D joint volume also proved to be accurate, with 3D volume measurements of the Lisfranc joint displaying the most significant absolute difference between the intact state and increasing severity of Lisfranc injury. These findings suggest that 2D joint area and 3D joint volume may have potential as supplementary measurements to more accurately diagnose subtle Lisfranc injuries.
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NewsBot · Aug 21, 2024

The utility of point-of-care dynamic ultrasonography for the diagnosis of subtle isolated ligamentous Lisfranc injuries: a cadaveric study
Samir Ghandour et al
Skeletal Radiol. 2024 Aug 13. doi: 10.1007/s00256-024-04771-8

Objectives: To assess if Lisfranc injury can be detected by US with and without abduction stress.

Methods: Eight cadaveric feet were obtained. The following measurements were obtained in the uninjured feet: C1M2 and C1C2 intervals and TMT1 and TMT2 dorsal step-off distances. Measurements were obtained both with and without abduction stress using ultrasound. The injury model was created by transecting the Lisfranc ligament complex, after which the observers performed the measurements again. Statistical analysis was used to identify differences between intact and injured models, to determine diagnostic cut-off values for identifying Lisfranc injuries, and to assess interobserver/intraobserver reliability.

Results: There was a significant difference in the mean C1M2 interval, both with and without abduction stress, between the intact and torn Lisfranc ligament (p < 0.001). A C1M2 interval with stress of > 2.03 mm yielded 81% sensitivity and 72% specificity for Lisfranc disruption. There was no significant difference in the mean C1C2 interval of the torn versus intact Lisfranc ligament without stress (p = 0.10); however, the distance was significantly different with the application of stress (p < 0.001). The C1C2 interval of > 1.78 mm yielded 72% sensitivity and 69% specificity for Lisfranc injury under stress. There were no significant differences in the mean TMT1 or TMT2 dorsal step-off measurements between the intact and torn Lisfranc ligaments. All observers showed good intraobserver ICCs. The interobserver ICCs for all measurements were good or excellent, except for TMT1, which was moderate.

Conclusion: Ultrasonography is a promising point-of-care imaging tool to detect Lisfranc ligamentous injuries when measuring C1M2 and C1C2 distances under abduction stress.
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NewsBot · Sep 16, 2024

High risk and low incidence diseases: Lisfranc injury
Anya McDermott et al
Am J Emerg Med. 2024 Sep 11

Introduction: Lisfranc injuries are uncommon but frequently misdiagnosed and carry a high rate of morbidity.

Objective: This review highlights the pearls and pitfalls of Lisfranc injuries, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

Discussion: Lisfranc injuries are caused by high- or low-energy trauma to the tarsometatarsal (TMT) joint complex. The severity of injury exists on a spectrum, ranging from minor subluxations to fractures and dislocations involving the TMT joint complex. They can be complicated by compartment syndrome, neurovascular compromise, and open fractures. Prompt diagnosis is critical in preventing chronic pain and mobility challenges, as even small subluxations can result in significant morbidity. Lisfranc injuries should be considered in all patients with a foot injury. Patients with Lisfranc injuries most commonly present with midfoot pain, swelling, or ecchymosis. Despite the importance of a timely diagnosis, Lisfranc injuries are commonly missed on plain radiographs due to their often subtle findings. When x-rays are negative but there is significant clinical suspicion, emergency clinicians should obtain advanced imaging such as computed tomography to aid in diagnosis. All Lisfranc injuries should be discussed with orthopedic surgery to determine definitive management. Patients who can be discharged should be made non-weightbearing and placed in a short-leg splint.

Conclusion: The consideration of Lisfranc injuries can help emergency clinicians make a timely diagnosis to prevent future complications.
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NewsBot · Oct 12, 2024

Can Early Treatment of Lisfranc Injuries Without Planned Re-Intervention be Safely Performed
Daniel T. DeGenova et al
Source

The Lisfranc complex is a unique combination of ligamentous and osseous relationships between the medial cuneiform and second metatarsal base that is often injured by high energy mechanisms. Fixation for these injuries is often operative; however, the optimal timing of surgical treatment has been debated. All patients who underwent operative fixation of a Lisfranc injury at a single urban tertiary care center were reviewed. Patient were split into two groups based on timing to fixation with one group being less than 24 hours from presentation and a second group being greater than 24 hours. There were 58 patients who underwent what was planned as final operative stabilization of their Lisfranc injury in less than 24 hours and 41 patients who underwent fixation after more than 24 hours. The early treatment of Lisfranc injuries did not lead to significant increases in follow up time, infections, time to weight bearing, union rates, or time to union compared patients treated with delayed fixation. There was a higher rate of superficial infection in the early intervention group, but it did not reach statistical significance. We believe our findings demonstrate that delayed fixation is not superior to early treatment of Lisfranc injuries.
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NewsBot · Oct 13, 2024

Can Early Treatment of Lisfranc Injuries Without Planned Re-Intervention be Safely Performed
Daniel T DeGenova et al
J Foot Ankle Surg. 2024 Oct 8:S1067-2516(24)00243-6

The Lisfranc complex is a unique combination of ligamentous and osseous relationships between the medial cuneiform and second metatarsal base that is often injured by high energy mechanisms. Fixation for these injuries is often operative; however, the optimal timing of surgical treatment has been debated. All patients who underwent operative fixation of a Lisfranc injury at a single urban tertiary care center were reviewed. Patient were split into two groups based on timing to fixation with one group being less than 24 hours from presentation and a second group being greater than 24 hours. There were 58 patients who underwent what was planned as final operative stabilization of their Lisfranc injury in less than 24 hours and 41 patients who underwent fixation after more than 24 hours. The early treatment of Lisfranc injuries did not lead to significant increases in follow up time, infections, time to weight bearing, union rates, or time to union compared patients treated with delayed fixation. There was a higher rate of superficial infection in the early intervention group, but it did not reach statistical significance. We believe our findings demonstrate that delayed fixation is not superior to early treatment of Lisfranc injuries.
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NewsBot · Oct 25, 2024

Primary Arthrodesis or Open Reduction and Internal Fixation for Lisfranc Injuries: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Lachlan Mactier et al
Foot Ankle Orthop. 2024 Oct 18;9(4)

Background: Lisfranc injuries are often managed surgically with primary arthrodesis (PA) or open reduction and internal fixation (ORIF); however, neither approach has been shown to be superior. This systematic review and meta-analysis assessed randomized controlled trials (RCTs) to compare the functional and surgical outcomes of PA and ORIF in the treatment of Lisfranc injuries.

Methods: This study was performed as per the PRISMA protocol. Database searches were conducted on Cochrane, Embase, and PubMed libraries. Five RCTs were identified for inclusion involving 241 patients, of which 121 underwent PA and 120 underwent ORIF.

Results: Statistically significant differences in visual analog scale pain score at 2 years (mean difference 0.89, 95% CI 0.18-1.59), patient satisfaction (OR 10.04, 95% CI 1.78-56.76), and all-cause return to surgery (OR 27.31, 95% CI 12.72-58.63) were observed, all favoring PA. There were no statistically significant differences between PA and ORIF with regard to American Orthopaedic Foot & Ankle Society midfoot scores at 2 years, 36-Item Short Form Health Survey (SF-36) scores, and unplanned return to surgery.

Conclusion: This study showed significant improvement in pain at 2 years, patient satisfaction, and all-cause return to surgery favoring PA in all instances. Given ORIF often necessitates a second operation for hardware removal, it is to be expected that all-cause return to surgery is higher in ORIF groups. Overall, these results do not have the power to confer an advantage to a particular approach because of significant heterogeneity. Further studies should focus on larger patient cohorts and longer follow-up, or analysis stratified by patient demographics and injury presentation. In the absence of clinically significant differences, cost-benefit analyses should be considered to answer the question of whether to "fix or fuse" for Lisfranc injuries.
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NewsBot · Nov 8, 2024

Functional Outcome and Patient Satisfaction After Primary vs Secondary Arthrodesis for Lisfranc Injuries: Toward a Single-Surgery Approach
Esmee Wilhelmina Maria Engelmann et al
Foot Ankle Int. 2024 Nov 6

Background: The choice between primary arthrodesis (PA) and open reduction and internal fixation (ORIF) for acute Lisfranc injuries remains contentious. Apart from primary treatment, arthrodesis is often used for treating chronic Lisfranc injuries, including patients in whom initial ORIF or nonoperative treatment failed. The aim of this study was to compare PA and secondary arthrodesis (SA) in terms of complications and functional outcome.

Methods: A retrospective cohort study was conducted on trauma patients with Lisfranc injuries treated at a level 1 trauma center between July 1, 2010, and July 1, 2020. Selected patients were evaluated at the outpatient clinic and received a survey. Demographics, injury characteristics, management, complications, and patient-reported outcomes (American Orthopaedic Foot & Ankle Society midfoot score, Foot Function Index) were analyzed.

Results: Twenty-nine of 37 potential patients (78.4%; PA n = 11, SA n = 18) completed the survey with a median follow-up of 7.1 (PA) to 9.3 (SA) years (P = .01). The majority were female (n = 18, 62.1%); the mean age of PA patients was 57.1 years (SD 14.2) compared with 43.5 years (SD 17.1) in SA patients (P = .04). In the PA group, there was no infection, 100% union, and implants were removed in 5 of 11 patients. In the SA group, 11.1% (n = 2) developed infection, malunion rate was 11.1%, implants were removed in 33.3% (n = 6), and 22.2% required revision surgery. AOFAS was "good" in PA (77.7, SD 17.3) compared with rated "fair" in SA (67.1, SD 21.3, P = .19). FFI was better in PA (26.0, SD 26.2) than SA (37.6, SD 30.8, P = .32), which exceeded the minimally important clinical difference.

Conclusion: Although this study was limited by sample size, the overall results suggest equivalent functional outcome, pain and treatment satisfaction in primary arthrodesis compared with secondary arthrodesis patients for treatment of Lisfranc injury.
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NewsBot · Nov 26, 2024

Operative versus non-operative treatment for non-displaced Lisfranc injuries: A two-center randomized clinical trial
Ville Ponkilainenet al
Scand J Surg. 2024 Nov 25

Background and aims: There is no consensus on which Lisfranc injuries can be treated non-operatively. The aim of the study was to compare non-operative treatment and open reduction and internal fixation (ORIF) in the treatment of non-displaced Lisfranc injuries.

Materials and methods: This study was a multicenter randomized controlled trial (RCT) conducted at two hospitals in Finland between 19 March 2012, and 20 December 2022, with a target sample size of 60 patients. The primary outcome was Visual Analogue Scale Foot and Ankle (VAS-FA) at 2 years. The secondary outcomes included VAS-FA pain, function, and other complaints subscales and the American Orthopedic Foot & Ankle Society (AOFAS) Midfoot Scale. All outcomes were measured at 6 months, 1 and 2 years.

Results: Altogether 27 patients with computed tomography (CT)-confirmed non-displaced Lisfranc injuries were enrolled in this trial resulting in an underpowered trial. In patients with non-displaced Lisfranc injuries, the mean VAS-FA overall score in the non-operative group was 96.1 [confidence interval (CI): 91.5-100] and 91.8 [86.9-96.7] in the ORIF group at 2 years with no statistically significant difference between the groups (mean between-group difference (MD) 4.3 [CI, -2.4 to 11], Cohen's d = 0.706) in this underpowered RCT.

Conclusion: There was no difference in VAS-FA between non-operative and ORIF in patients with non-displaced Lisfranc injuries, but the trial is underpowered to draw robust conclusions.
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NewsBot · Dec 1, 2024

Biomechanical analysis of a magnesium plantar plate prototype system for the first tarsometatarsal joint fusion: a cadaveric study
Peng Zhou et al
J Orthop Surg Res. 2024 Nov 28;19(1):802

Background: Titanium plantar plates have proven successful in the fixation of the first tarsometatarsal arthrodesis (TMT). However, a second surgery is typically needed for implant removal, and potential adverse effects, carried by the conventional implantations, are not uncommon. The purpose of this study was to determine whether a novel magnesium-based plantar plate system provides similar fusion stability to a titanium-based plantar plate system under various loading conditions.

Methods: Six matched-pair human cadaveric specimens underwent TMT fusions using either a magnesium plantar plate system prototype or a titanium plantar plate system. Specimens were cyclically loaded with a force ranging from 5 N to 50 N for 5,000 cycles, and displacement was recorded. Axial stiffness (N/mm) was calculated from load-displacement curves. Each specimen was loaded to failure at a rate of 5 mm/min, and the ultimate load was recorded.

Results: No significant difference was found in the vertical displacement between Ti group and Mg group after 100 cycles (2.4 ± 1.0 mm vs. 1.3 ± 1.4 mm, p = 0.196), 500 cycles (3.3 ± 1.3 mm vs. 1.7 ± 1.7 mm, p = 0.142), 1,000 cycles (3.7 ± 1.5 mm vs. 1.9 ± 1.9 mm, p = 0.128), 2,500 cycles (4.2 ± 1.7 mm vs. 2.3 ± 2.2 mm, p = 0.172) and 5,000 cycles (4.5 ± 1.8 mm vs. 2.3 ± 3.3 mm, p = 0.125), Additionally, no significant differences were observed in initial stiffness (53.1 ± 19.2 N/mm vs. 82.2 ± 53.9 N/mm, p = 0.257), final stiffness (90.6 ± 48.9 N/mm vs. 120.0 ± 48.3 N/mm, p = 0.319), or maximum load-to-failure (259.8 ± 98.2 N vs. 323.9 ± 134.9 N, p = 0.369).

Conclusions: Based on the performed biomechanical testing, the magnesium plantar plate system provides mechanical stability equivalent to the titanium plantar plate system in fixation for the first TMT joint fusion.
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NewsBot · Dec 5, 2024

Acute Lisfranc injury management
Freideriki Poutoglidou et al
Bone Joint J. 2024 Dec 1;106-B(12):1431-1442

Lisfranc injuries were previously described as fracture-dislocations of the tarsometatarsal joints. With advancements in modern imaging, subtle Lisfranc injuries are now more frequently recognized, revealing that their true incidence is much higher than previously thought. Injury patterns can vary widely in severity and anatomy. Early diagnosis and treatment are essential to achieve good outcomes. The original classification systems were anatomy-based, and limited as tools for guiding treatment. The current review, using the best available evidence, instead introduces a stability-based classification system, with weightbearing radiographs and CT serving as key diagnostic tools. Stable injuries generally have good outcomes with nonoperative management, most reliably treated with immobilization and non-weightbearing for six weeks. Displaced or comminuted injuries require surgical intervention, with open reduction and internal fixation (ORIF) being the most common approach, with a consensus towards bridge plating. While ORIF generally achieves satisfactory results, its effectiveness can vary, particularly in high-energy injuries. Primary arthrodesis remains niche for the treatment of acute injuries, but may offer benefits such as lower rates of post-traumatic arthritis and hardware removal. Novel fixation techniques, including suture button fixation, aim to provide flexible stabilization, which theoretically could improve midfoot biomechanics and reduce complications. Early findings suggest promising functional outcomes, but further studies are required to validate this method compared with established techniques. Future research should focus on refining stability-based classification systems, validation of weightbearing CT, improving rehabilitation protocols, and optimizing surgical techniques for various injury patterns to ultimately enhance patient outcomes.
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NewsBot · Dec 22, 2024

Efficacy comparison of dorsal approach and medical approach in treating Lisfranc injury
Z D Li et al
Zhonghua Yi Xue Za Zhi. 2024 Dec 17;104(47):4297-4302

Objective: To compare the efficacy of dorsal approach and medial approach in the treatment of Lisfranc injury. Methods: A retrospective cohort study was conducted to analyze the clinical data of 43 patients with closed Lisfranc injuries admitted to Tongji Hospital of Tongji University from January 2017 to December 2021. The surgical approach were open reduction and internal fixation or metatarsal cuneiform joint fusion, with 23 cases using the dorsal approach and 20 cases using the medial approach. The duration of surgery, incisional complications, loss of internal fixation, internal fixation removal rate, patient's clinical satisfaction, and American Orthopedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score of pain in the patients were reviewed based on the medical record system and follow-up records. Results: Of the patients, 33 were male and 10 were female, with a mean age of (45.2±13.4) years. All the patients were followed up for (17.9±6.7) months, and there was no statistically significant differences in the baseline data between the two groups. Preoperatively, the dorsal approach group and the medial approach group had a AOFAS score of (30.3±10.7) and (28.5±9.3), respectively, and a VAS score of (6.2±1.9) and (6.3±2.1), respectively (both P>0.05); the operation time was (112.2±25.0) min and (91.0±22.5) min, respectively in the two groups (P=0.006). Two patients in the dorsal approach group developed superficial infection in the incision, one patient experienced delayed healing in the medial approach group, while the remaining patients achieved primary healing. In the dorsal approach group, three patients suffered long-term numbness or pain on the dorsum of the foot during follow-up, which was alleviated with neurotrophic medications; in the medial approach group, one patient had abnormal sensations around the wound site, which gradually improved. During the follow-up period, a total of 10 patients underwent internal fixation removal, including 7 patients (30.4%) in the dorsal approach group and 3 patients (15.0%) in the medial approach group (P=0.294). The AOFAS score in the dorsal approach group and the medial approach group at the last follow-up was 83.8±7.7 and 86.7±6.9 (P=0.207), and the VAS scores was 2.1±1.0 and 1.3±0.5 (P=0.002), respectively, both showed improvement when compared with those before the surgery (both P<0.001). In both groups, the internal fixations were all in place, with no cases of lost implants. In the dorsal approach group, 3 patients (13.0%) were dissatisfied with the surgical outcome, while in the medial approach group, 1 patient (5%) was dissatisfied (P=0.848). Conclusions: Both surgical approaches resulted in a good prognosis, and there is no statistical difference between the two groups in terms of fixation effect, and the medial approach group is superior to the dorsal access in operative time, internal fixation removal rate, VAS score and patient clinical satisfaction.
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NewsBot · Jan 23, 2025

Midfoot fractures: Patterns of injury and predictors of stability
Serena Patel et al
J Clin Orthop Trauma. 2024 Dec 22:61:102874.

Background: Lisfranc injuries describe a spectrum of midfoot and tarsometatarsal joint (TMTJ) trauma ranging from purely ligamentous to multiple fracture-dislocations. Lisfranc injuries represent 0.2 % of all fractures and are seen predictably, with mechanisms involving a fall from height, crushing, or torsion. Diagnosis can be challenging, with approximately 20 % of cases being missed, and relies upon clinical acumen and proficient image interpretation. Whilst multiple classification systems have described Lisfranc injuries using a 3-column concept, these add zero prognostic value and are therefore rarely used clinically. Furthermore, existing literature on diagnosis and management is limited to retrospective small series.

Methods: We present a review of 161 midfoot injuries, with the aim of highlighting characteristics of radiological instability and indication for operative management. CT scans and weight-bearing and non-weight-bearing X-rays were reviewed for features of joint instability. These features included metatarsal base, cuneiform and cuboid fractures, tarsometatarsal joint subluxation or dislocation and C1-MT2 diastasis. The subsequent "stable" and "unstable" injury groups were then compared to identify statistically significant indicators for instability.

Results: Avulsion and intra-articular fractures of the medial, middle, or lateral column were all suggestive of instability. Although these appeared in multiple combinations, 95 % involved the middle column. Concomitant inter-cuneiform and cuboid fractures were additional indicators of instability. In cases of uncertain midfoot instability, weight-bearing radiographs were of value with 14.2 % demonstrating a diastasis of C1-MT2 >2 mm.

Conclusion: We propose the need for a new classification of midfoot injuries which emphasises the diagnosis of instability and guides surgical management. We propose that, based on non-weight-bearing X-ray and CT scans, these injuries can be initially classified as "stable", "unstable", or "stability uncertain". Weight-bearing X-rays are a safe and reliable method of detecting instability in the "stability uncertain" group. Fractures of the medial column and cuneiform on initial imaging were suggestive of midfoot instability.
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NewsBot · Jan 24, 2025

The Mid- and Long-Term Consequences After Surgically Treated Lisfranc Injuries: A Case Series and Review of the Literature
Laura Fontanella et al
Cureus. 2024 Nov 27;16(11):e74591

Background Long-term follow-up data are difficult to collect, especially in uncommon foot injuries. Therefore, it is rare to find publications that include patient-reported outcomes. Therefore, a case series and systematic review are provided to evaluate mid- and long-term outcomes. Methods Patients operated for a Lisfranc injury in our hospital, between 2010 and 2016, were included. Patients were invited to fill out a combined European Foot and Ankle Score (EFAS) and Short Form (SF-12) questionnaire and to undergo an x-ray of the operated foot. In addition, a systematic review of the literature was performed, and our results were compared with that review. Results Fourteen out of 29 patients (48%, four male, 10 female) were seen at a mean follow-up of 8.3 years. Initial Hardcastle & Myerson Classification was: two A (14%); one B1 (7%); 10 B2 (71%); and one C2 (7%). Three patients underwent multiple surgeries: one external fixation followed by definitive stabilization, and two received fasciotomies (14%). The median EFAS score was 15.5, the EFAS sports score was 14, the SF-mental score was 55.73, and the SF-physical score was 48.25. There was substantial variability in outcomes between patients. 12 patients (86%) also underwent a follow-up X-ray exam, demonstrating a mean Kellgren-Lawrence score of 2.7. In the systematic review, 20 studies and 1052 feet with an average follow-up of 73 months met the inclusion criteria. Most cases underwent K-wire fixation (396 feet, 37.6%). Screw-only fixation was the next most common treatment (306 feet, 29.1%), followed by plate fixation (46 feet, 4.4%). Only three studies present primary arthrodesis in 68 (7.5%) cases. In 47 of the 686 patients (6.8%) with osteosynthesis (open reduction and internal fixation (ORIF)) a secondary definitive arthrodesis of the Lisfranc joint was required later. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 75. Conclusion Patients need to be informed about the possibility of limitations of activity, including sporting activity. Mid-term follow up studies are manly limited to ORIF. No operative technique shows an advantage in the mid-term.
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NewsBot · Apr 4, 2025

Lisfranc Injury: a Comprehensive Analysis of LongTerm Outcomes - the Oswestry Experience
R Patel et al
Acta Chir Orthop Traumatol Cech. 2024;91(6):369-375

Purpose of the study: Lisfranc is a challenging injury both diagnostically and surgically, with sparse long-term literature evidence of surgical practice. We aim to review our long-term specialist orthopaedic institutional experience of Lisfranc injuries and the surgical management of this complex injury, specifically considering surgical outcomes as per radiological and clinical assessment.

Material and methods: We present data from a prospectively maintained institutional database, reviewing patients who underwent operative fixation for Lisfranc injury between April 2014 and August 2020. Patients were referred to our institution from hospitals across the country. We included all operatively managed Lisfranc injuries, primary procedures, and patients over the age of 16. Revision procedures, open injuries, polytrauma patients, patients under the age of 16, and those with multiple foot injuries were excluded. We assessed post-operative results as per the Wilpulla radiographic and clinical criteria.

Results: We treated 27 patients across the study period, of mean age 37.5 (SD 18.3), 55% male and 45% female. 33.3% of our patients were obese as defined by body mass index >30. As per the Myerson classification, we had 2 category A, 24 category B, and 1 category C injuries. Time to operation was median 14 days (range 0-116), with 2 delayed presentations following failure of conservative treatment. Our median length of stay was 1 day (range 0-16). We had 3 complications: 2 wound infections and 1 re-operation for non-union. Post-operative assessment as per Wilpulla demonstrated 74% of good, 18.5% fair and 7% poor fixation results.

Conclusions: In our institutional experience, partial congruity lateral displacement injuries were the majority of surgical referrals. Surgical treatment through open reduction and internal fixation delivers good clinical and radiographically anatomical results. Further to conventional mechanisms of injury, we propose obesity to be an important risk factor for indirect, low-energy injuries that may help identify this injury.
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NewsBot · Apr 4, 2025

The Topographic Map of the Midfoot: Implication for Improving Safety of Dorsal Approach of Midfoot Surgeries
Abdul Veli Ismailoglu et al
J Am Acad Orthop Surg Glob Res Rev. 2025 Jan 7;9(1):e24.00339.

Purpose: The surgical approach for midfoot injuries classically requires dual dorsal incision and identification of the neurovascular structures that are susceptible to injury during the surgery. The aim of this study was to map the topographic anatomy of the dorsum of the foot along with tarsal joints for the dorsal approach of midfoot surgery that would facilitate the surgery and minimize the risk of neurovascular injuries for surgeons who specially focus on foot and ankle injuries.

Methods: The dorsum of the foot was evaluated in 12 feet injected with latex containing a red colorant to visualize the arterial vessels. The navicular line, originating from the navicular tuberosity (NT) and passing over the dorsum of the foot, was used as a reference line. Dorsal foot neurovascular structures including cutaneous branches and muscles were mapped with respect to the tarsal joints and navicular line.

Results: The deep peroneal nerve and dorsalis pedis artery were coursing between the base of the first and second metatarsal bones over which the tendon of the extensor hallucis brevis muscle was passing. The tendon of extensor hallucis brevis was crossing over the deep peroneal nerve and dorsalis pedis artery 55.2 mm superior and 45.0 mm lateral, respectively, from the NT.

Conclusion: This cadaver study supplies a detailed topographic map of the dorsum of the foot using the tarsal joints and NT as landmarks for protecting the neurovascular structures to facilitate midfoot surgeries for sports medicine surgeons who specially focus on foot and ankle injuries.
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NewsBot · Apr 9, 2025

Long-term results of staged management of complex lisfranc and chopart injury: a retrospective cohort study and systematic literature review
Esmee W M Engelmann et al
Eur J Trauma Emerg Surg. 2025 Jan 24;51(1):49

Purpose: The aim was to assess the long-term functional outcome and quality of life after staged surgical treatment of complex Lisfranc and Chopart injuries in a patient cohort, and to perform a systematic review of the literature.

Methods: A retrospective cohort of all trauma patients with complex Lisfranc and/or Chopart injuries treated at our level 1 trauma center between July 1, 2010, and July 1, 2020 with ≥ 3 years follow-up was analyzed in terms of management, complications, and patient-reported outcomes (American Orthopaedic Foot & Ankle Society midfoot score, AOFAS and Foot Function Index, FFI). A systematic review of the literature (according to PRISMA 2020 guidelines) was performed of studies published between January 2000 to April 2024. Inclusion criteria were acute, complex Lisfranc and/or Chopart injury, staged treatment, age ≥ 17 years, patient-reported outcome measures and ≥ 1 year follow-up.

Results: Fifteen patients with a median follow-up of 6.6 years (interquartile range 4) were included. First stage treatment involved temporary K-wire fixation (n = 11), debridement (open fractures, n = 4), external fixation (n = 4) and decompression fasciotomy (n = 3). Second stage included primary arthrodesis (n = 4), open reduction and internal fixation (n = 7) or external fixation (n = 1). The median number of surgeries was 3 (2-13). Infection was seen in 5/15 patients; 7/11 patients underwent secondary arthrodesis and one patient underwent amputation due to chronic pain. Overall AOFAS was fair (54.5) and five patients had poor outcome (AOFAS < 49). Three full-length articles were included in the systematic review, reporting fair to good outcome. Risk of bias was serious and certainty of evidence very low.

Conclusion: Surgical management of complex Lisfranc and Chopart injuries is challenging, functional outcome was poor to fair, postoperative complication rates are high, and secondary salvage arthrodesis was required in two thirds of ORIF patients.
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NewsBot · May 24, 2025

Midfoot Arthrodesis after Failed Lisfranc Open Reduction and Internal Fixation
Megan L Campbell et al
J Orthop Trauma. 2025 Apr 14.

Objectives: To determine the incidence and risk factors for secondary arthrodesis (SA) and compare patients who underwent primary arthrodesis (PA) versus SA following ORIF for Lisfranc injuries.

Methods: Design : Retrospective cohort.

Setting: Single tertiary level 1 trauma center.

Patient selection criteria: Adult patients treated surgically for Lisfranc injuries AO/OTA 85.1A-C +/- 85.2.A-C, 85.3A-C; 87.1.1A-C-87.5.1A-C; 89B) between 2003-2023 were included.

Outcome measures and comparisons: Patients who underwent index PA were compared to those who underwent index ORIF and subsequent SA. A composite primary outcome was used for comparison which included the development of adjacent midfoot arthrosis, midfoot collapse, or mal/nonunion rated satisfactory, suboptimal, poor, or severe; secondary outcomes were PROMIS measures of physical function (PF) and pain interference (PI). Descriptive and comparative statistics, multivariable analysis, and logistic regression were utilized to compare groups.

Results: Of 489 Lisfranc injuries (482 patients), index treatment for 98 (20%) was PA. Average age was 37.7y (SD 15.6); mean follow up was 2.3y (SD 8.8). Fifty six percent of patients were men. There were thirty-four SAs (8.7% of index ORIF group). Patients who underwent SA were more likely to develop a poor (21.9% vs. 6.5% p=0.021) or severe outcome (12.5% vs. 1.1%, p=0.015) compared to those who underwent PA (OR 5.1, CI 1.4-18.5; OR 12.7, CI 1.1-12.8). Patients requiring SA also had significantly higher PI and significantly lower PF at final follow-up (p=0.018, p<0.001). Divergent injuries had higher odds of needing a SA compared to homolateral injuries (OR 6.9, p=0.006), as did index treatment with a tightrope (OR 4.6, p=0.003).

Conclusions: Nine percent of patients underwent SA after index ORIF of their Lisfranc injury, and outcomes fared substantially worse than those treated with PA. This emphasizes the importance of identifying risk factors for patients that may fail ORIF. Further work is needed to clearly delineate which patients may best be served with PA.
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NewsBot · May 28, 2025

Diagnosis and assessment of subtle Lisfranc injuries: Comparison of computed tomography and weight-bearing radiography
Hiroki Ukita et al
J Orthop Sci. 2025 May 15:S0949-2658(25)00125-3.

Background: Subtle Lisfranc injuries cause instability around the Lisfranc joint, leading to loss of foot function without appropriate treatment. The diagnostic accuracy of the commonly used Nunley classification, which is based on weight-bearing radiographs, is controversial. We compared the Nunley classification and computed tomography (CT) findings for subtle Lisfranc injury severity.

Methods: Fifty-one patients diagnosed with subtle Lisfranc injury were retrospectively enrolled. After excluding those without weight-bearing radiography or CT images, the medical histories, weight-bearing radiographs, and CT images of 33 patients were reviewed. We measured the distance between the proximal first and second metatarsals from the anteroposterior radiographs and that between the plantar aspect of the first cuneiform and plantar aspect of the fifth metatarsals from the lateral view and then classified the cases according to the Nunley classification. CT images were evaluated for avulsion fragments at the Lisfranc ligament complex attachment sites.

Results: According to the Nunley classification, seven patients were stage I, 23 were stage II, and three were stage III. Based on weight-bearing radiographs, the C1-M5 distance was 1.29 ± 0.40 cm/1.01 ± 0.36 cm (injured feet/contralateral feet; p < 0.05) overall. On CT images, the avulsion bone fragment location revealed one case of interosseous Lisfranc ligament and five cases of plantar capsular Lisfranc ligament complex in Nunley stage I. In Nunley stage II, three patients had a dorsal capsular Lisfranc ligament complex, 15 had an interosseous Lisfranc ligament, and 18 had a plantar capsular Lisfranc ligament complex. In Nunley stage III, two patients had interosseous Lisfranc ligaments, and three patients had a plantar capsular Lisfranc ligament complex.

Conclusions: Patients in the acute phase of subtle Lisfranc injury did not place weight on their injured foot. In 93.9 % of subtle Lisfranc injury cases, avulsion fragments were present at the ligament attachment site, and severity was different from weight-bearing radiographs.
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NewsBot · Jun 19, 2025

Classification in 157 patients with Lisfranc injuries using three-dimensional fracture lines and heat map
Lei Zhang et al
J Orthop Surg Res. 2025 Mar 12;20(1):266.

Background: Recently Lisfranc fractures have increased due to increased high-energy injuries from various causes. However, due to incomplete traditional classification, the pattern and distribution of fractures cannot be analyzed in three dimensions. This study examines a novel fracture pattern based on the fracture line and heat map for Lisfranc injuries.

Methods: We retrospectively analyzed data from CT scans of 157 patients diagnosed with Lisfranc injuries. We extracted the CT data of a healthy adult and created a standard foot model. We performed 3D reconstruction using patients' CT images and superimposed the fracture model onto the standard model for drawing fracture lines. Subsequently, we converted the fracture lines into a heat map for visualization.

Results: The novel classification identifies high-density fracture sites within the tarsometatarsal joint, predominantly localized in the medial and lateral columns. The fracture lines not involving the TMT joint are mainly located in the medial aspect of the first metatarsal trunk and the fifth metatarsal trunk. Additionally, we develop an assessment protocol for Lisfranc injury that incorporates ligament injury, displacement, and fracture.

Conclusion: The new classification accurately identifies the different types of fractures in Lisfranc injuries, enabling clinicians to more fully and accurately understand their patients' injuries and assisting them in efficiently making sound decisions to avoid diagnostic delays that can negatively impact postoperative outcomes.
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NewsBot · Jun 28, 2025

Concomitant lisfranc injuries in the setting of ankle fractures: A case series
Emily M Shipman et al
Foot (Edinb). 2025 Jun 25:64:102179.

Lisfranc injuries are rare and commonly misdiagnosed, which can lead to severe complications. This paper presents patients with concomitant Lisfranc injuries and ankle fractures. We report 3 cases. Case 1 is a 14-year-old girl with trimalleolar fractures and Lisfranc dislocation who achieved a full recovery. Case 2 is a 55-year-old woman with complex Lisfranc and ankle fractures, where delayed intervention resulted in persistent instability and pain. Case 3 is a 62-year-old woman with a previously missed Lisfranc injury with an ankle fracture that was fixed with full recovery after correct diagnosis. The purpose of this study is to illustrate the necessity of monitoring for Lisfranc injuries in the setting of ankle fractures to prevent misdiagnosis and long-term complications.
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NewsBot · Jun 28, 2025

Risk factors for screw breakage in Lisfranc joint injuries: A multicenter retrospective study
Satoshi Muto et al
Source

Background
Lisfranc joint injuries are rare but significantly impact foot biomechanics. Open reduction and internal fixation (ORIF) using screws is common, but screw breakage is a frequent issue. While previous studies have reported breakage rates, few have investigated the association between screw type and breakage risk.
Purpose
This study aims to identify risk factors for screw breakage, analyze the timing and patterns of failures, and evaluate their impact on clinical outcomes.
Study design
Multicenter retrospective cohort study.
Methods
This multicenter retrospective study analyzed 233 patients who underwent surgical treatment for Lisfranc injuries at 11 institutions between January 2014 and June 2024. After applying the exclusion criteria, 72 patients were eligible for inclusion in the study. These patients were divided on the basis of screw type (cannulated [n=31] and solid [n=41]). Following age- and sex-matching, 48 patients were selected (Group C: cannulated, n=24; Group S: solid, n=24).
Results
Screw breakage occurred more frequently in Group C (28.6%) than in Group S (3.6%) (p=0.004). The median time to breakage was 39 weeks (range: 8–54). Logistic regression analysis revealed that usage of cannulated screws was a significant risk factor for breakage (OR 0.132, 95% CI 0.0252–0.694; p=0.0167). Despite higher breakage rates, Group C had better final AOFAS scores (median 95.00 vs. 90.00, p=0.031). Among the 11 broken screws, 7 (63.6%) were retained without adverse effects on functional outcomes.
Conclusion
Cannulated screws were associated with increased breakage risk in Lisfranc injuries, although this did not negatively impact functional outcomes
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NewsBot · Jun 28, 2025

Outcomes and complications after open reduction and internal fixation of Lisfranc injuries: a retrospective cohort study
Ioannis Stavrakakis, Ioannis Sperelakis, Konstantinos Zampetakis, Alexandros Tsioupros, Alkison Kotsis, Alexandros Zikopoulos, Orestis Konstantas, Andreas F Mavrogenis & Theodoros H. Tosounidis
European Journal of Orthopaedic Surgery & Traumatology

Purpose

To investigate the clinical and radiographic outcomes of Lisfranc injuries treated with open reduction and internal fixation.
Methods

A retrospective cohort study reporting on the operative management of Lisfranc injuries was conducted across three institutions. Data from adult patients who sustained a tarsometatarsal joint fracture dislocation and were treated with open reduction and internal fixation from 1 January 2020 to 31 December 2023 were collected. The mean AOFAS midfoot score, the incidence of post-traumatic arthritis (PTA) and the complications were reported. The AOFAS score of anatomically reduced TMT joints was compared to the AOFAS score of the non-anatomically reduced TMT joints. The correlation of PTA to the quality of reduction was also evaluated.
Results

Thirty-six (36) consecutive adult patients were retrieved from the digital patient registry. Thirty-two (32) patients completed the six-month follow-up (FU) and were included in the study. The mean AOFAS score of the entire cohort was 89,44 (range 70–100). The anatomically reduced fractures demonstrated a mean AOFAS score of 91,41 (95% CI 88,14–94,68), whereas the mean AOFAS score of the non-anatomically reduced Lisfranc joints was 85,10 (95% CI 77,38–92,82). This difference was statistically significant (p-value: 0,031). Thirteen (13) of 32 patients (40,6%) developed PTA. PTA occurrence was strongly correlated to the quality of reduction (OR: 4,33, 95% CI 1,60–11,69, p-value < 0,001). Four patients developed complex regional pain syndrome (CRPS), and broken implants were identified in four patients. One patient developed metatarsalgia, one deep infection and another one a painless flatfoot. High-energy injuries, PTA and obesity were the most important factors negatively affecting the outcome.
Conclusion

A better outcome and a lower risk of PTA were correlated with anatomically reduced Lisfranc fracture dislocations. The most commonly documented complications were PTA, implant breakage and CRPS.
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Outcome of surgically treated Lisfranc injury

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Outcome of surgically treated Lisfranc injury

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Mental health and outcomes of foot and ankle surgery

Predicting the outcome of plantar heel pain

Does Patient-Reported Outcome Measures Use at New Foot Patient Visits Improve Patient Outcomes?

Outcomes of Achilles tendinopathy

Association of erectile dysfunction with diabetic foot and its outcomes in type 2 diabetic men

The Influence of Pain and Resiliency on Foot and Ankle Surgery Outcomes

Gender Differences in Seeking Health Care in Pain Outcomes in Foot Patients

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