Outcome after open reduction and internal fixation of Lisfranc joint injuries

Background: Open reduction and internal fixation has been recommended as th e treatment for most unstable injuries of the Lisfranc (tarsometatarsal) jo int. It has been thought that purely ligamentous injuries have a poor outco me despite such surgical management. Methods: We performed a retrospective study of patients who underwent open reduction and screw fixation of a Lisfranc injury in a seven-year period. A mong ninety-two adults treated for that injury, forty-eight patients with f orty-eight injuries were followed for an average of fifty-two months (range , thirteen to 114 months). Fifteen injuries were purely ligamentous, and th irty-three were combined ligamentous and osseous. Patient outcome was asses sed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) mid foot score and the long-form Musculoskeletal Function Assessment (MFA) scor e. Results: The average AOFAS midfoot score was 77 points (on a scale of 0 to 100 points with 100 points indicating an excellent outcome), with patients losing points for mild pain, decreased recreational function, and orthotic requirements. The average MFA score was 19 points (on a scale of 0 to 100 p oints, with 0 points indicating an excellent outcome), with patients losing points because of problems with "leisure activities" and difficulties with "life changes and feelings due to the injury." Twelve patients (25 percent ) had posttraumatic osteoarthritis of the tarsometatarsal joints, and six o f them required arthrodesis. The major determinant of a good result was ana tomical reduction (p = 0.05). The subgroup of patients with purely ligament ous injury showed a trend toward poorer outcomes despite anatomical reducti on and screw fixation. Conclusions: Our results support the concept that stable anatomical reducti on of fracture-dislocations of the Lisfranc joint leads to the best long-te rm outcomes as patients so treated have less arthritis as well as better AO FAS midfoot scores.