Outcomes after nonoperatively treated non-displaced Lisfranc injury: a retrospective case series of 55 patients

Abstract

Background Current knowledge of the role of the nonoperative treatment of Lisfranc injuries is based on a few retrospective case series. Hence, consensus on which patients can be treated nonoperatively does not exist. The aim of this study was to investigate outcomes after nonoperative treatment of Lisfranc injuries. Methods In this study, patients were collected by recruiting all computer tomography-confirmed Lisfranc injuries treated during a 5-year period at a major trauma hospital. Between 2 and 6 years after suffering the injury, patients completed the visual analogue scale foot and ankle questionnaire. Results In total, 55 patients returned adequately completed questionnaires and were included in the study. Of those, 22 patients had avulsion fractures and 33 had simple non-displaced intra-articular fractures. Of these patients, 30 (55%) scored over 90 points in both the pain and function subscales of the VAS-FA, and 35 (64%) scored over 90 points overall. In addition, three (5%) patients scored under 60 points in both the pain and function subscales of the VAS-FA, and four (7%) scored under 60 points overall. Only one patient with avulsion fractures underwent secondary surgery. Conclusion Nonoperative treatment has a role in the treatment of Lisfranc injuries, and the results of our study support the view that avulsion and simple intra-articular fractures with < 2 mm of displacement can be treated nonoperatively with high functional outcomes. The results of nonoperative and operative treatment should be compared in a prospective randomized controlled study setting in future studies. Level of evidence IV, retrospective case series

Comparing bilateral feet computed tomography scans can improve surgical decision making for subtle Lisfranc injury

“…Similarly Choi et al reported that overall AOFAS score of patients who underwent open reduction and internal fixation for SLI was 85.7 [6]. On the other hand, Ponkilainen et al investigated 55 patients with < 2 mm of C1M2 avulsion in NWB CT who were treated nonoperatively [26]. Overall patient-reported outcome measure with visual analog scale foot and ankle was over 90 points in 64% and over 80 points in 78% of them.…”

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

“…15 High-energy mechanisms of injury, which comprised the majority of our cases, are considered at more risk for soft tissue complications and arthrosis. 16,17 Based on frequent loss of fixation, persistent pain, and PTA, many surgeons have advocated for primary arthrodesis in a subset of Lisfranc injuries. 9,18 After ORIF, a high rate of unplanned secondary surgery was identified.…”

“…15 High-energy mechanisms of injury, which comprised the majority of our cases, are considered at more risk for soft tissue complications and arthrosis. 16,17…”

Management of Lisfranc Injuries

“…Patients presenting with clinical features suggestive of a midfoot sprain (localized midfoot pain, swelling and/or bruising) but with ≤2 mm gap between the medial cuneiform and the second metatarsal base on weight-bearing radiographs and/or CT/MRI imaging may be suitable for nonoperative treatment in appropriately selected patients 40,44 . Ponkilainen et al followed up 55 patients of an initial cohort of 110 who were treated initially in a non–weight-bearing cast for 4 to 6 weeks, followed by full weight-bearing for a further 4 weeks 45 . At a minimum follow-up of 2 years, patients reported excellent function according to the visual analog scale (VAS)-foot and ankle, and only 1 patient required delayed operative intervention.…”