Epidemiology, Treatment and Outcome of 169 Lisfranc Fracture/Dislocations Layseca A, Bastías G, Zagal P, Reyes N, Delgado M, Gutierrez R, Verschae G. Foot and Ankle Unit Hospital del Trabajador Santiago, Chile
No conflicts to disclose My disclosure is in the final AOFAS mobile app I have no potential conflicts with this presentation
Introduction Lisfranc Fractures/D islocations are part of a wide and poorly described spectrum of injuries. There is no unified treatment algorithm published in the literature and in many cases treatment is defined on a case to case basis.
Introduction Secondary OA is the most common complication. Arthrodesis of the lisfranc joint is the gold standard for secondary OA. Open reduction vs Primary Arthrodesis has been matter of debate in the last decade, specially in those cases with high probability of secondary OA or pure ligamentous lesion.
Patients and Methods We present a retrospective series including 169 patients with Lisfranc injuries managed in our institution between January 2010 and December 2013 Epidemiologic data was collected with description of management according to each type of lesion. In addition to this, we analized patients who required secondary arthrodesis and its association with: Type of lesion Mechanism of injury Worker ś compensation involvement Type of treatment (ORIF vs Primary Arthrodesis) At follow up we reviewed the presence of posttraumatic arthritis requiring arthrodesis, weeks to full weight bearing and return to work
Results C olumn involvement included: Only medial column in 82 patients (59%) Medial-m iddle column in 12 patients (9%) 3 column involvement in 40 patients (29%). Operative treatment included: ORIF in 162 patients (97,63%) Primary arthrodesis in 7 cases (3%) Full weight bearing was allowed in average at 21 weeks and 13 weeks respectively.
Results Thirteen patients (8%) developed posttramatic degenerative arthritis that required midfoot arthrodesis at average 9,6 months after fixation. Of this patients, 12 had workers compensation involvement and nine had two or more affected columns at the primary lesion. Nevertheless, there was no significant association between these variables and risk of arthrodesis.
Results 169 Patients 162 ORIF 97% 7 Primary Arthrodesis 4% 157 Screws (95 percutaneus) 5 Plating 13 Secondary Arthrodesis Secondary arthrodesis rate: 8% (13/162) 9,6 months postoperative (mean) Hardware removal: 29,6% (48/162) 7 months postoperative (mean) 4 patients with persistent pain Secondary Arthrodesis
Results Secondary Arthrodesis vs. No secondary arthrodesis No statistical difference was found comparing Gender (p.011) Workers compensation involvement (p 0,13) Smoking (p 0,36) Pure Ligamentous Injury (p 0,25) Compartimental Syndrome (p 0,29) Type of Fixation Screws vs Plate (p 0,99) Open vs Percutaneus (p 0,78) Hardware removal (p 0,45) Type of fracture Medial vs Medial & Middle (p=0,37) Medial vs 3 Columns (p=0,48) Medial & Middle vs 3 Columns (p=0,20)
Conclusions This results support the concept that Lisfranc injuries are more common in men and with high energy mechanisms. Our management is mainly based on ORIF, but we prefered primary arthrodesis in selected cases. Patients involved in worker ś compensation and two or more column involvement had a tendency to develop posttramatic degenerative arthritis requiring secondary arthrodesis with no statistical significance. Nevertheless, this type of patients may be suitable candidates for primary arthrodesis.
Bibliography Watson et al. Treatment of Lisfranc Joint Injury: Current Concepts J Am Acad Orthop Surg 2010;18:718-728 Henning J. Et al. Open Reduction Internal Fixation versus Primary Arthrodesis for Lisfranc Injuries: A Prospective Randomized Study. Foot Ankle Int 2009 30: 913 Coetzee C. Making sense of lisfranc injuries. Foot Ankle Clin N Am 13 (2008) 695 704 Eleftheriou K, Rosenfeld P. Lisfranc Injury in the Athlete Evidence Supporting Management from Sprain to Fracture Dislocation. Foot Ankle Clin N Am 18 (2013) 219 236