Functional Outcome of Lisfranc Injury after Open Reduction and Internal Fixation with Transarticular Screws A Prospective Observational Study Section Original Research Paper

Abstract

Introduction:  The term ‘Lisfranc injury’ refers to an injury in which one or more of the metatarsals are displaced with respect to the tarsus. The use of this term is very broad and can refer to a low-energy sports injury or a high-energy lesion, as well as lesions that are purely ligamentous or those that are associated with fractures of the metatarsals, cuneiform bones, or cuboid bone. Early and accurate diagnosis of these injuries are fundamental requirements for their appropriate treatment and to prevent long-term sequelae. Early accurate diagnosis combined with prompt anatomical reduction and stable internal fixation provides optimal results. Objectives: To evaluate the functional outcome of Lisfranc injury after open reduction and internal fixation using transarticular screw fixation after a follow up of minimum period of 6 months using AOFAS midfoot score.  Methods: The study was conducted as a  prospective observational study at the Department of Orthopaedics, Government Medical College, Thiruvananthapuram during the period January 2020 to May 2021. Sixty eight consecutive patients of 20-70 years, who underwent surgical fixation for lisfranc injury using transarticular screw fixation were followed up. Functional outcomes at one year follow up were assessed. Results: Most of the patients were between age group of 31 to 40 with mean age 42(SD±1.2). In the study 41 were males (60.3%) and 27 (39.7%) were females. Road traffic accidents (RTA) was the mode of injury for 46 patients (68%). 18 (26%) sustained injuries due to fall from height and 4 (6%) due to crush injury. Eight patients (11.8%) had open fractures and 60 (88.2%) had closed injury. Anatomical reduction was obtained in 55 patients (81%). Post-operative arthritis was seen in 16 patients (23.5%), implant failure in 5 (7.4%) and 3 (4.4%) patients needed a second surgery. The mean AOFAS mid foot score was 78.8 (SD±1.62). Sixty one (89.7%) patients had good score ≥60. Conclusion: The  study with transarticular screw fixation for Lisfranc fractures showed  very good functional outcome. Our results support the concept that stable anatomical reduction of fracture-dislocations of the Lisfranc joint leads to the best long-term outcomes. Although it was not free of complications, our study has shown very good results. Further biomechanical studies and clinical trials are required to evaluate the validity of screws for the treatment of Lisfranc injuries.