Fixation in Missed Lisfranc Injuries: Should This Be Attempted?

Abstract

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: The Lisfranc injuries are not so uncommon. However, subtle injuries are often either missed or misdiagnosed as “mid foot sprain” during initial assessment. Missed lisfranc injuries causes various problems like chronic pain, fallen medial arch, functional loss etc. The decision regarding whether to fix such missed or chronic injuries or to do an arthrodesis is still a topic of debate. So the purpose of this study was to evaluate the outcomes of delayed fixation of missed lisfranc injuries. Methods: A total of 10 patients with missed lisfranc injuries (more than 6 weeks after injury) were included in the study. Most of the patients had previous history of subtle, low energy injuries to their foot which was treated conservatively. All the patients preoperatively underwent weight bearing radiographs of foot and distance between lateral border of medial cuneiform and medial border of 2nd metatarsal base were measured for degree of displacement. Patients were treated with an open reduction and internal fixation as opposed to arthrodesis. Outcomes were assessed using VAS score, American Orthopaedic Foot & Ankle Society (AOFAS) Mid foot score, post operative radiographic evaluation and return to work time. Out of 10 patients, 70% were female and 30% were male. The average time interval between injury and surgery was 9.6 + 2.50 weeks. The mean age was 41.5 and mean follow up duration was 33.6 + 12.98 months. Results: The average degree of displacement between lateral border of medial cuneiform and medial border of 2nd metatarsal base was 5.14 mm. At final follow up no patients had radiographic signs of a late diastasis at the Lisfranc joint. The pre operative VAS score improved from 7.5 + 1 to 1.6 + 0.69 post operatively. One patient had developed arthritis at 1st and 2nd TMT joints but did not had any symptoms. The average AOFAS mid foot score pre & post operatively was 37.6 + 10.8 & 84.2 + 6.54 respectively, with two patients having excellent outcome, six patients having good outcome and two patients having fair outcome. At final follow up all patients could perform their ADL & recreational activities independently. Conclusion: Subtle, low velocity missed lisfranc injuries can be well managed with open reduction and internal fixation. In our series, delayed fixation resulted in decreased pain scores and a fair to good functional outcome and returned to their pre injury work.