Percutaneous fixation of Lisfranc joint injuries: A systematic review of the literature

Abstract

ObjectiveThe aim of this systematic review was to present the outcome of Lisfranc joint injuries treated with closed reduction and screw percutaneous fixation.MethodsWe searched in Pubmed and Google Scholar Databases for articles regarding screw percutaneous fixation of Lisfranc injuries. Seven studies in total were found to be compatible to our search, according to PRISMA guidelines. Four of those met the criteria of the review and they were included in the meta-analysis. A total number of 106 patients were separated into five groups according to the type of injury and the mean AOFAS score of each group was calculated. Cases in which percutaneous fixation was converted to open treatment due to poor reduction were not included in the study. In addition we compared the outcome score between types of injury according to Myerson classification as well as between purely ligamentous and osseoligamentous injuries. The characteristics of all seven selected studies, such as kind of screw used for fixation, post operative protocol, complications and outcome are mentioned as well.ResultsAverage AOFAS score was 86,2 for type A, 87,54 for type B, and 85 for type C injuries respectively. In pure dislocation group the average AOFAS score was 86,43 and in fracture dislocation group was 87,36. Good to excellent outcome can be expected in patients with different types of injury according to Myerson classification following percutaneous fixation of lisfranc joint injury. Patients with type B injury or a fracture dislocation injury might have better outcome, although this difference was not found to be statistically significant.ConclusionPercutaneous fixation of tarsometatarsal joint injuries is a relatively simple and safe method of treatment, leading to a good functional outcome, especially for Myerson type B as well as for fracture dislocation type of injuries, provided that an anatomical reduction has been achieved.Level of EvidenceLevel III, Therapeutic Study.

Updates on Lisfranc Complex Injuries

“…In a systematic review of 106 patients, Stavrakakis et al demonstrated good functional outcomes for patients treated with closed reduction and percutaneous fixation. 61 The main benefit of percutaneous fixation like other minimally invasive operative techniques is a reduction in soft tissue damage and minimization in morbidity from traditional open surgeries. 67 However, when compared to closed reduction, open reduction better achieves anatomic restoration.…”

Management of Lisfranc Injuries

“…Only 1 systematic review on percutaneous fixation has been performed by Stavrakakis et al, including just 4 studies, which concluded that percutaneous fixation was simple, safe, and with a low operative morbidity 55 . However, as with any periarticular injury, a positive outcome was reliant on anatomical reduction, and some authors consider an open reduction mandatory for all subtle Lisfranc injuries to prevent missing concomitant joint injury, which if left untreated may lead to post-traumatic arthritis 21 .…”

Percutaneous Treatment With Bridge Plate and Extra-articular Screws in Low-Energy and High-Energy Lisfranc Injuries

“…Another controversial point is the infection and dehiscence rates related to the surgical wound needed for reduction which reach up to 12.5% in a systematic review published in 2019 5,6…”

“…4 Another controversial point is the infection and dehiscence rates related to the surgical wound needed for reduction which reach up to 12.5% in a systematic review published in 2019. 5,6 With the emergence of minimally invasive surgery in the trauma setting, and bearing in mind that the percentages of complications and sequelae despite the good results in reduction quality are still important, we began to use minimally invasive surgery reduction and fixation in the treatment of Lisfranc complex injuries.…”