SLR - February 2019 - Steven Stuto
Midterm Functional Outcomes in Operatively Treated Adolescent Lisfranc Injuries
Reference: Cheow X, Lam KY. Midterm Functional Outcomes in Operatively Treated Adolescent Lisfranc Injuries. Pediatr Orthop B. 2018 Sep;27(5):435–442.
Scientific Literature Review
Reviewed By: Steven Stuto, DPM
Residency Program: University Hospital, Newark, NJ
Podiatric Relevance: Lisfranc injuries are fracture dislocation injuries involving tarsometatarsal joints. These injuries can be caused by low-energy injuries as well as high-energy injuries. Twenty percent of such injuries are missed or misdiagnosed on initial evaluation. This study evaluated the midterm outcomes of Lisfranc injuries in adolescents operatively treated with Kirschner wire or screw fixation.
Methods: This article is a level 4 retrospective case series based in Singapore from 2009 to 2014. The Myerson Classification was used to classify the injuries. They attempted to assess the degree of intermetatarsal distance prereduction versus postreduction six months after surgery using the American Orthopedic Foot and Ankle Society (AOFAS) Midfoot Scale. The AOFAS classification focuses primarily on pain, function and alignment. The exclusion criteria included: 1) Postoperative follow-up period of less than 12 months, 2) Age older than 16 years and 3) Presence of associated hindfoot fractures. All procedures were performed under general anesthesia. The fixation device that was utilized was either Kirschner wires 1.6 or 2.0 mm or partially threaded cancellous screws.
Results: There were eight adolescent patients with Lisfranc injuries operatively treated. The mean duration of follow-up was 3.8 years. Five cases were open reduction with three of the cases closed reduction. The mean intermetatarsal distance prereduction and postreduction at six months was 4.03 and 1.75 mm, respectively. Three patients started walking before the removal of implants. The mean score on the AOFAS Midfoot Scale administered was 93.4 at 3.8 years postoperatively.
Conclusion: The authors concluded good anatomical reduction is essential for a good outcome in the treatment of Lisfranc injuries. Psychological issues may play a role in the perception of pain. Fixation techniques may play a role in postoperative pain reduction. A larger screw could cause more articular surface damage while a K-wire could cause less articular surface damage and ultimately could reduce pain. A major drawback of this study is the small sample size studied.