Long-Term Outcome of High-Energy Open Lisfranc Injuries: A Retrospective Study
Reference: Nithyananth M., et al. Long-Term Outcome of High-Energy Open Lisfranc Injuries: A Retrospective Study. J Trauma. 70(3):710-6. 2011.
Scientific Literature Review
Reviewed By: Kelsey A. Barrick, DPM
Residency Program: Grant Medical Center
The outcome of open Lisfranc injuries is infrequently reported in the medical literature. Several studies have looked at closed Lisfranc injuries and treatment options have been widely debated including: reduction methods, fixation methods, and the role of primary arthrodesis in severe injuries. To date, this is the only study that examines outcomes exclusively in high energy, open Lisfranc injuries.
Twenty-two patients with high-energy, open Lisfranc injuries were retrospectively reviewed between 1999 and 2005. Mean follow-up was 56 months. Types of dislocations, functional and radiologic outcomes, and complications were recorded. All patients were treated operatively within 48 hours of injury, with a 5 mm opening of the joint surface as an indicator for Kirschner wire fixation. Standard protocol for treatment by one of five surgeons included: debridement, open reduction, Kirschner wire fixation, external fixator if needed, and secondary soft tissue coverage.
All of the Lisfranc injuries were Gustilo Anderson type IIIa or IIIb with modified Hardcastle classification of type B2 being the most common. Mean time to wound healings was 16 days, with nine patients requiring split thickness skin grafting for soft tissue coverage. One patient had osteomyelitis at the final follow-up. Radiographic analysis revealed anatomic reduction in eight patients and non-anatomic reduction in five patients. No patients had a secondary loss of reduction. TMT fusion was observed 10 patients, which correlated with TMT comminution during the initial injury. The functional outcome, measured by AOFAS score, was a mean of 82. All but two patients returned to their pre-injury occupation.
Kirschner wire fixation, along with early debridement and open reduction is a viable option for open, high-energy Lisfranc injuries. Secondary soft tissue coverage can be achieved at a later date if needed. Fractures with initial TMT comminution are more likely to go on to arthrodesis. Regardless of whether anatomic reduction is obtained during initial surgical intervention, mean patient AOFAS functional outcome was 82 in patients followed for a mean of 56 months.