Staged Management of Missed Lisfranc Injuries: A Report of Short-term Results

Objective: Lisfranc joint injury is a rare injury and can be easily missed at the initial treatment. Once ignored, late reduction is very difficult and requires extensive dissection. Surgical outcome is not as good as in the case of an early reduction. The aim of this cohort study was to analyze the midterm clinical and radiographic outcomes of staged reduction and fixation in a consecutive series of patients with old Lisfranc injuries.

Methods: Fifteen patients (16 feet) with missed Lisfranc injuries were treated with staged reduction. Mean duration between injury and surgery was 4.8 months (3-8 months). In the first stage, an external fixator was applied across the Lisfranc joint or/and Chopart joint and distraction was done at 1-2 mm/day. In the second staged, open reduction and internal fixation (ORIF) were done and we were able to reduce all the fractures and dislocations.

Results: The mean duration between two surgeries was 3.2 weeks (range, 2.5-4.5 weeks). Anatomic reduction was obtained in all 15 patients. At the last follow-up point, 7 feet had good functional results, 5 feet fair, and 4 feet poor functional results. In the 4 patients who achieved poor functional results, 2 cases were due to severe injuries to the articular surface and tissue scaring; 2 cases were due to loss of reduction. For the 4 feet with poor functional results, 2 were scheduled for secondary arthrodesis during the follow-up. The average American Orthopaedic Foot and Ankle Society Midfoot Scale (AOFAS) scores for these patients were 75.8 points (range, 43-98 points). The pain visual analog scale (VAS) was 3.1 points at the final follow-up.

Conclusion: Our study demonstrated that staged reduction and extra-articular fixation should be considered for old Lisfranc injuries with a good reduction, firm stability, and low risk of intraoperative fracture and soft tissue complications.