The Journal of Bone and Joint Surgery 82:1609 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Outcome After Open Reduction and Internal Fixation of Lisfranc Joint Injuries*
R. S. Kuo, M.B.B.S., F.R.A.C.S. ,
N. C. Tejwani, M.D. ,
C. W. DiGiovanni, M.D. ,
S. K. Holt, M.S.P.H.#,
S. K. Benirschke, M.D.#,
S. T. Hansen, Jr., M.D.# and
B. J. Sangeorzan, M.D.#
Investigation performed at the Department of Orthopaedics,
Harborview Medical Center, Seattle, Washington
*No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
P.O. Box 913, Strathfield, Sydney, New South Wales 2135, Australia.
E-mail address: rodkuo{at}yahoo.com
550 First Avenue, New York University, NB 10N27, New York, N.Y.
10016.
§Department of Orthopaedics, Brown University School of Medicine,
Rhode Island Hospital, Providence, Rhode Island 02905.
#Department of Orthopaedics, Harborview Medical Center, 325 Ninth
Avenue, Seattle, Washington 98104.
Background: Open reduction and internal
fixation has been recommended as the treatment for most unstable
injuries of the Lisfranc (tarsometatarsal) joint. It has been thought
that purely ligamentous injuries have a poor outcome 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. Among ninety-two adults
treated for that injury, forty-eight patients with forty-eight injuries
were followed for an average of fifty-two months (range, thirteen
to 114 months). Fifteen injuries were purely ligamentous, and thirty-three
were combined ligamentous and osseous. Patient outcome was assessed
with use of the American Orthopaedic Foot and Ankle Society (AOFAS)
midfoot score and the long-form Musculoskeletal Function Assessment
(MFA) score.
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 points,
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 of them required arthrodesis. The major determinant of
a good result was anatomical reduction (p = 0.05). The subgroup
of patients with purely ligamentous injury showed a trend toward
poorer outcomes despite anatomical reduction and screw fixation.
Conclusions: Our results support the concept
that stable anatomical reduction of fracture-dislocations of the Lisfranc
joint leads to the best long-term outcomes as patients so treated
have less arthritis as well as better AOFAS midfoot scores.
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