SLR - December 2022 - McKayla Seymour, DPM
Title: Staged Surgery for Closed Lisfranc Injury With DislocationReference: He, W., Xia, J., Zhou, H., Li, Z., Zhao, Y., Yang, Y., & Li, B. Staged surgery for closed Lisfranc injury with dislocation. Front Surg. 2022 Aug 19;9:984669.
Level of Evidence: Level II
Scientific Literature Review
Reviewed By: McKayla Seymour, DPM
Residency Program: Eastern Virginia Medical School, Norfolk, VA
Podiatric Relevance: There is debate in the literature regarding the preferred surgical treatment for an acute Lisfranc injury, whether that be open reduction internal fixation (ORIF), primary fusion, or a staged intervention. Taking time to evaluate the fracture pattern and soft tissue envelope following a Lisfranc injury is crucial. While it is important to allow the soft tissue envelope time for the swelling to decrease and fracture blisters to subside, this may lead to fascial compartment syndrome making it challenging to achieve intraoperative reduction. This study evaluated outcomes of a two staged surgical approach versus a single staged surgical approach for an acute closed Lisfranc injury.
Methods: 48 patients with acute closed Lisfranc dislocations admitted from July 2016 to July 2021 were evaluated. The inclusion criteria consisted of closed injuries following a fall from height or MVA and >18 years of age. Patients were divided into two groups based on severity of soft tissue injury and risk for compartment syndrome. Twenty-three were categorized to group A and underwent a two-staged intervention as they were considered high risk. Stage 1, which was performed within 4-8 hours of injury, consisted of closed reduction and percutaneous pinning or open reduction with percutaneous pinning. Stage 2 performed 6-10 days following injury consisted of a combination of 1st tarsometatarsal (TMT) fusion, Lisfranc screw, intercuneiform screw, cuboid plating, and K-wire pinning fourth and fifth TMTJ. Group B encompassed 25 patients who underwent a single staged intervention due to minimal swelling and low risk for compartment syndrome between 10-20 days following injury. Surgical intervention consisted of a combination of 1st TMT fusion, Lisfranc screw, intercuneiform screw, cuboid plating, and K-wire pinning fourth and fifth TMTJ. American Orthopedic Foot and Ankle Score (AOFAS), visual analog scale (VAS), length of hospital stay, and length of surgery were recorded and evaluated. Scores were compared using paired t- tests.
Results: Group A results showed average length of hospital stay was 11.52 ±1.61 days, AOFAS 86.87 ± 4.24, VAS 1.91 ± 0.78, and length of surgery 67.34 ± 1.71 mins. Group B results showed average length of hospital stay 19.80 ± 2.37 days, AOFAS 71.72 ± 5.46, VAS 3.20 ± 1.17, and length of surgery 104. 36 ± 8.31 mins. The AOFAS score, VAS score, length of hospital stay, and length of surgery differed significantly between groups A and B (p < 0.05).
Conclusions: This study concluded that staged surgical treatment for high energy acute closed Lisfranc injuries led to reduced length of hospital stay and operation time, increased AOFAS score, and decreased VAS score as compared to single staged surgery. The author noted that TMT fusion with the use of a Lisfranc screw did not lead to any re-dislocations. All incisions preformed in the first stage healed and aided in direct visualization of the injured area providing decompression and planning for stage two. Further studies need to be conducted with large sample sizes to further validate the use of a staged approach.