A single surgeon's experience of treatment of Lisfranc joint injuries

This paper assesses the outcomes and complications of Lisfranc joint injuries treated at a regional trauma centre under the care of a single surgeon. We performed a retrospective study of all patients that underwent ORIF of a Lisfranc joint injury over a 5-year period. Case note review, radiology review, and questionnaire assessment were performed. We analysed for correlations between outcome and injury type, mechanism of injury, and presence of other ipsilateral limb injury and pure ligamentous injury. All injuries were classified according to a system described by Myerson et al. (Types A, B1, B2, C1, C2). Radiographs were also assessed for the presence of pure ligamentous injury. Outcome was measured using the American Orthopaedic Foot and Ankle society (AOFAS) midfoot score. Twenty-five injuries (24 patients) were identified and 16 injuries (15 patients) were available for follow. The mean duration of follow up was 42.6 months (11-69). The mean outcome score was 78.3 (38-100). The outcome scores for pure ligamentous injury (74.9) and for mixed bony and ligamentous injury (80.9) had no significant difference (p=0.61). High-energy trauma accounted for 50% of cases, and scored significantly less than low energy trauma (69.1 versus 87.4, p<0.05). There was an associated injury in the ipsilateral limb in 31% of cases and this group had a poorer outcome (63.0 versus 85.3, p<0.035). The most common injury type was B2 (38%). Type C2 injuries (divergent with total displacement) had a worse outcome than the mean outcome of all other categories (60.5 versus 84.4, p<0.01). Our mean outcome from ORIF of Lisfranc joint injuries is comparable to internationally quoted figures. Pure ligamentous injuries did no worse statistically than mixed bony and ligamentous injuries. Poorer outcome was associated with high-energy trauma, associated injury on the ipsilateral limb, and Type C2 injuries.