Complications and outcomes after fixation of Lisfranc injuries at an urban level 1 trauma center

Abstract

OBJECTIVES: To evaluate patients with tarsometatarsal fractures and dislocations and describe complications and secondary operations METHODS: Design: Retrospective cohort study Setting: Level 1 trauma center Patient Selection Criteria: Consecutive adults treated acutely for Lisfranc injuries with reduction and fixation using standard techniques of rigid medial fixation and flexible lateral fixation Outcome Measures and Comparisons: Complications: infections, wound healing problems, nonunion, malunion, and post-traumatic arthrosis (PTA) and secondary unplanned procedures after minimum two-year radiographic follow-up. RESULTS: Mean age of the included 118 patients was 40 years (range, 18-73) and 96 (74%) were male. Comorbidities included obesity (n=32: 40%), diabetes mellitus (n=12: 9%), and tobacco use (n=67: 52%). Thirty (23%) were open injuries, and concomitant forefoot injuries were present in 47% and hindfoot injuries in 12%. Unplanned secondary procedures, including implant removals, were performed on 39 patients (33%), most often for removal of painful implants (26%) or infectious debridement (9%). 67 complications occurred, with PTA most frequent (37%). Deep infections occurred in 8%. On multivariate analysis, open injury (p=0.028, CI=1.22 – 30.63, OR=6.12) and concomitant forefoot injury (p=0.03, CI=1.12 – 9.76, OR=3.31 were independent risk factors for complication. CONCLUSIONS: Open Lisfranc injuries were associated with complications with deep infections occurring in 9%. Secondary procedures were most often performed for pain relief; the most common late complication was PTA, warranting counseling of patients about potential long-term sequelae of injury. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.