Results of isolated Lisfranc injuries and the effect of compensation claims

Abstract

The results of treatment of Lisfranc injuries are often unsatisfactory. This retrospective study investigated 46 patients with isolated Lisfranc injuries at a minimum of two years after surgery. Thirteen patients had a poor outcome and had to change employment, or were unable to find work as a result of this injury. The presence of a compensation claim (p = 0.02) and a delay in diagnosis of more than six months were associated with a poor outcome (p = 0.01). There was no association between poor functional outcome and age, gender, mechanism of injury or previous occupation. This study may have medico-legal implications on reporting the prognosis for such injuries, and highlights the importance of prompt diagnosis and treatment.Lisfranc injuries are dislocations and fracture dislocations through the tarsometatarsal joints. The outcome for displaced injuries is improved following anatomical open reduction and internal fixation (ORIF), but up to 20% may be misdiagnosed or overlooked.

Screw and Wire Fixation for Lisfranc Fracture Dislocations

“…Treatment ranges from closed reduction with or without Kirschner wire fixation 17,24,25 to anatomic reduction and internal fixation with Kirschner wires and/or screws. [26][27][28][29][30] Such injuries are frequently missed or misdiagnosed, 18,31,32 as the plantar ecchymosis sign 33 (associated with toe dislocation) and the fleck sign at the base of the second metatarsal 22 are not well known. Road traffic accidents are commonest cause of fracture dislocations, whereas twisting usually causes dislocations without fractures.…”

The Treatment of Lisfranc Injuries: Review of Current Literature

“…Calder et al [35] reviewed a series of 32 patients with LFD. Based on their study, they state that it is important to note that those patients who pursue compensation claims following surgery for displaced Lisfranc injuries have a poor prognosis, independent of any other factors, such as age, type of injury, and gender.…”

The Diagnosis and Initial Management of Injury to Lisfranc’s Joints in the Primary Care Setting in South-Eastern Ontario : How are we Doing?

“…This is in contrast to the relatively acceptable outcomes that patients can expect if a timely diagnosis and operative stabilization is achieved in less than 4-6 weeks [1]. It is for this reason that medical-legal claims are also not uncommon when a lfi has been missed [5]. This highlights the importance of a healthy respect for the subtle presentation and the gravity of lfis.…”

“…This may lead to rapidly progressive osteoarthritis of the tmt joints. [1] These conditions are often refractory to operative management and in most cases, lead to chronic pain, losses in working productivity and large compensation claims [5]. This is in contrast to the relatively acceptable outcomes that patients can expect if a timely diagnosis and operative stabilization is achieved in less than 4-6 weeks [1].…”

“…Although much research has been aimed at the accuracy of various imaging modalities, the results of operative fixation, and the poor outcomes after missed diagnosis, [1,[3][4][5][6][7][8][9] little study has gone into assessing what role pcps potentially play in the missed diagnoses of subtle lfis. The purpose of this cross-sectional survey study was to assess the level of knowledge and comfort in assessing subtle lfis by pcps in southeastern Ontario, Canada.…”