Outcomes and complications after open reduction and internal fixation of Lisfranc injuries: a retrospective cohort study.

PURPOSE: To investigate the clinical and radiographic outcomes of Lisfranc injuries treated with open reduction and internal fixation.

METHODS

A retrospective cohort study reporting on the operative management of Lisfranc injuries was conducted across three institutions. Data from adult patients who sustained a tarsometatarsal joint fracture dislocation and were treated with open reduction and internal fixation from 1 January 2020 to 31 December 2023 were collected. The mean AOFAS midfoot score, the incidence of post-traumatic arthritis (PTA) and the complications were reported. The AOFAS score of anatomically reduced TMT joints was compared to the AOFAS score of the non-anatomically reduced TMT joints. The correlation of PTA to the quality of reduction was also evaluated.

RESULTS

Thirty-six (36) consecutive adult patients were retrieved from the digital patient registry. Thirty-two (32) patients completed the six-month follow-up (FU) and were included in the study. The mean AOFAS score of the entire cohort was 89,44 (range 70-100). The anatomically reduced fractures demonstrated a mean AOFAS score of 91,41 (95% CI 88,14-94,68), whereas the mean AOFAS score of the non-anatomically reduced Lisfranc joints was 85,10 (95% CI 77,38-92,82). This difference was statistically significant (p-value: 0,031). Thirteen (13) of 32 patients (40,6%) developed PTA. PTA occurrence was strongly correlated to the quality of reduction (OR: 4,33, 95% CI 1,60-11,69, p-value < 0,001). Four patients developed complex regional pain syndrome (CRPS), and broken implants were identified in four patients. One patient developed metatarsalgia, one deep infection and another one a painless flatfoot. High-energy injuries, PTA and obesity were the most important factors negatively affecting the outcome.

CONCLUSION

A better outcome and a lower risk of PTA were correlated with anatomically reduced Lisfranc fracture dislocations. The most commonly documented complications were PTA, implant breakage and CRPS.