SLR - August 2020 - Lucian M. Feraru
Undisplaced Subtle Ligamentous Lisfranc Injuries, Conservative or Surgical Treatment with Percutaneous Position Screws?
Reference: Ren W, Li HB, Lu JK, Hu YC. Undisplaced Subtle Ligamentous Lisfranc Injuries, Conservative or Surgical Treatment with Percutaneous Position Screws? Chin J Traumatol. 2019;22(4):196-201. doi:10.1016/j.cjtee.2019.03.005
Scientific Literature Review
Reviewed By: Lucian M. Feraru, DPM
Residency Program: St Mary’s General Hospital – Passaic, NJ
Podiatric Relevance: Nondisplaced Lisfranc injuries are often seen in midfoot injuries. Poor management of these injuries can lead to severe disability due to pain, loss of normal gait and dysfunction. This study’s goal is to answer the question of whether conservative treatment for non-displaced subtle Lisfranc injuries result in a worse outcome compared to early surgical intervention.
Methods: This is a retrospective study evaluating 61 Lisfranc’s injuries, 41 of which were treated conservatively and 20 received surgical treatment with minimally invasive percutaneous screws. For the conservative management group, patients were initially kept non-weight bearing using a posterior plaster splint for the first three days, followed by a full cast with arch remolding and ankle fixed at 90 degrees, non-weight bearing for six weeks. Patients were then allowed full weight bearing in a walking boot with arch support for the next six weeks. Surgically treated patients had diastasis reduced intraoperatively using a reduction clamp, followed by one screw, or two position screws if there was intercuneiform diastasis. Patients were placed in a posterior plaster splint for two weeks after wound healing, followed by CAM boot with arch support for the following four weeks.
Results: Patients managed surgically had significantly higher AOFAS and Maryland foot scores, as well as significantly lower FFI disability and pain scores compared to those treated conservatively. Patients in the conservative group had higher incidence of complications, including secondary diastasis (34.1 percent versus 5.0 percent), joint stiffness at three months (82.9 percent versus 0 percent) and secondary arthrodesis (12.2 percent versus 0 percent). Surgical patients experienced increased temporary foot pain post-operatively (55.0 percent).
Conclusions: The authors concluded that percutaneous fixation of subtle non-displaced Lisfranc injuries yields superior outcomes to conservative treatment. Lisfranc injuries are often subtle and may elude early identification. This article stresses the importance of obtaining weight-bearing radiographs as well as vigilance when evaluating a patient for midfoot trauma and ensuring adequate surgical treatment if a Lisfranc injury is indeed present. This article will help surgeons in their decision to recommend early operative treatment and provide patients with literature supporting surgical intervention versus conservative management.