Risk factors for postoperative complications in Lisfranc injuries treated with open reduction and internal fixation: A multicenter study.

BACKGROUND

Lisfranc injuries compromise foot stability and may lead to chronic instability and post-traumatic arthritis if inadequately treated. Open reduction and internal fixation (ORIF) is a standard surgical option, but multicenter data on risk factors for postoperative complications remain limited.

PURPOSE: To identify risk factors for postoperative complications and reoperation after ORIF for Lisfranc injuries.

STUDY

DESIGN

Multicenter retrospective cohort study.

METHODS

We retrospectively reviewed 172 adult patients who underwent joint-preserving ORIF for Lisfranc injuries at 11 hospitals between 2014 and 2024. No cases of primary arthrodesis were included. Patient demographics, injury characteristics, and fixation methods were analyzed. Multivariate logistic regression was performed to identify independent predictors of postoperative complications and reoperation.

RESULTS

Postoperative complications occurred in 119 patients (70.0%), most commonly post-traumatic arthritis (29.7%), malunion (22.1%), and sensory impairment (13.4%). Reoperation was required in 44 patients (25.6%), most commonly for unplanned implant removal (14.0%). Open fractures (adjusted odds ratio [AOR], 2.79; 95% confidence interval [CI], 1.23-6.35; p = 0.015) and high-energy injuries (AOR, 2.13; 95% CI, 1.07-4.26; p = 0.032) were independently associated with postoperative complications. Combined screw and plate fixation (AOR, 0.23; 95% CI, 0.069-0.79; p = 0.019) and screw fixation alone (AOR, 0.43; 95% CI, 0.20-0.94; p = 0.033) were associated with lower complication risk. No independent predictors of reoperation were identified.

CONCLUSION

Open fractures and high-energy injuries were independent risk factors for postoperative complications after ORIF for Lisfranc injuries. More robust fixation constructs, particularly combined screw and plate fixation, may help reduce complication risk.