SLR - December 2018 - Taylor D. Heck
Dorsal Bridge Plating or Transarticular Screws for Lisfranc Fracture Dislocations
Reference: Kirzner N, Zotov P, Goldbloom D, Curry H, Bedi H. Dorsal Bridge Plating or Transarticular Screws for Lisfranc Fracture Dislocations. Bone Joint J. 2018 Apr 1; 100-B(4): 468–474. doi: 10.1302/0301-620X.100B4.BJJ-2017-0899.R2.
Scientific Literature Review
Reviewed By: Taylor D. Heck, DPM
Residency Program: The Jewish Hospital, Cincinnati, OH
Podiatric Relevance: Treatment for Lisfranc fracture dislocations has remained controversial. Traditionally, the gold standard for treatment has been Open Reduction and Internal Fixation (ORIF) with transarticular screws. However, there has been a recent trend toward use of dorsal bridge plating in certain fracture dislocation patterns to avoid further articular cartilage damage to the joints from screw penetration. The purpose of this study was to compare functional and radiographic outcomes of dorsal bridge plating versus transarticular screw fixation or a combination of both plates and screws for Lisfranc fracture dislocations.
Methods: This retrospective review looked at a total of 108 patients for Lisfranc fracture dislocations between 2005 and 2016. Patients were divided into one of three groups, consisting of either bridge plating in 45 patients, transarticular screw fixation in 38 patients and a combination of plates and screws in 25 patients. Preoperative radiographs and CT scans were used to identify and categorize Lisfranc fracture dislocations based on the Myerson classification. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot scores and the validated Manchester Oxford Foot Questionnaire (MOXFQ). Finally, anatomic reduction was assessed with postoperative radiographs via the Wilppula classification and were classified as either good, fair or poor.
Results: The mean follow-up period was 34 months. Mean AOFAS midfoot scores were 82.5 for bridge plating group, 71.1 for transarticular screw fixation group and 63.3 for combination of plates and screws group. Mean MOXFQ scores were 25.6 for bridge plating group, 38.1 for transarticular screw fixation group and 45.5 for combination of plates and screws group. Of note, a lower score for MOXFQ indicates a better outcome. Anatomic reduction via Wilppula classification noted good or anatomic reduction in 37 of 45 cases for bridge plating group, 26 of 38 in transarticular screw group and 14 of 25 in combination of plates and screws group. Poor functional outcomes were associated with poor anatomic reduction and increased number of columns needing to be fixated.
Conclusions: Dorsal bridge plating for Lisfranc fracture dislocations resulted in better overall functional and radiographic outcomes compared to transarticular screws or combination of plates and screws. In general, anatomic reduction resulted in better functional outcomes regardless of fixation construct type. Primary arthrodesis should be considered in more severe injuries, such as those with multiple columns of involvement.