Title: Treatment of Primarily Ligamentous Lisfranc Joint Injuries: Primary Arthrodesis Compared with Open Reduction and Internal Fixation
Authors: Ly TV, Coetzee JC
Source: The Journal of Bone and Joint Surgery 2006; Vol.88-A, Number 3: 514-520.
PODIATRIC RELEVANCE:
Injuries of the Lisfranc joint are rare. However, these injuries are commonly missed or misdiagnosed. If not treated promptly and adequately, Lisfranc joint injuries can result in undesirable outcomes and cause chronic disability. Painful osteoarthrosis often develops in a majority of these patients. This article discusses and compares open reduction and internal fixation with primary arthrodesis in the treatment of primarily ligamentous Lisfranc joint injuries.
METHODS:
A prospective study involving 41 patients with an isolated primarily ligamentous Lisfranc injury, randomized to either the arthrodesis group or the open-reduction group. Patients in the arthrodesis group were treated with primary arthrodesis of medial two or three rays. Open reduction group underwent open reduction with internal screw fixation of the medial two or three rays. If instability of the 4th and 5th rays existed, they were stabilized with K-wires in both groups. Post-operative follow-up was performed at two weeks, six weeks, three months, six months and then annually. Outcomes were evaluated with clinical examination, radiography, a visual analog pain scale, the AOFAS Midfoot scale and a clinical questionnaire.
RESULTS:
Anatomic initial reduction was obtained in 18 of the 21 patients in the open reduction group and 20 of the 21 patients in the arthrodesis group. Average time to fusion was 10.6 weeks. Seven of the twenty one patients in the open reduction group required conversion to tarsometatarsal fusion secondary to loss of correction, increased deformity and degenerative joint disease. At the time of final follow-up, the average score on visual analog pain scale was 4.1 points in the open reduction group and 1.2 points in the arthrodesis group with the AOFAS score of 68.6 and 88 respectively. Patients reported their postoperative level of activities at 92% of the preinjury level in the primary arthrodesis group and 65% in the open reduction group.
COMMENTS:
Anatomic reduction is critical in treating Lisfranc injuries, however, the optimal treatment method for these injuries is still very controversial. Most, if not all, patients develop significant degenerative joint disease subsequent to Lisfranc injuries despite appropriate initial treatment. Therefore, it is important to evaluate each injury individually, keeping in mind the joints involved and the function of those joints in the foot in order to decide on a treatment option that will be more realistic for that particular patient.
________________________________________________________________________________________
Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.