Outcomes After Percutaneous Reduction and Fixation of Low-Energy Lisfranc Injuries

Lisfranc injuries are often missed initially or not anatomically reduced, leading to midfoot collapse, arthrosis, and pain. Operative management of these injuries is also fraught with complications, particularly with respect to the soft tissues. Wound dehiscence and infection are not uncommon. The goal of this study was to analyze the outcomes of a minimally invasive technique in reduction and percutaneous fixation of low-energy minimally displaced Lisfranc injuries and determine if it is a safe alternative to more traditional, open approaches.

A retrospective review was performed for all patients who underwent minimally invasive Lisfranc treatment at a single institution over a 6-year period. Thirty-eight patients were identified in this series. All patients were skeletally mature and had a minimum follow-up of 3 years. Patients were assessed clinically and radiographically, in addition to undertaking patient-centric outcome scoring using the Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL) and sports subscales at a mean follow-up of 66 months (range, 36-100). Patients were also asked to subjectively rate their percentage return to preinjury functional level at the time of final follow-up. There were 20 males and 18 females. Seventeen patients were injured participating in sports-related activities, 19 during falls, and 2 as a result of motor vehicle accidents. The average age at the time of surgery was 34.2 (range, 16-69) years. At final follow-up, 31 patients were available for assessment (81.6%).

The mean FAAM-ADL score was 94.2 (range, 40.5-100), and sports score was 90.4 (range, 0-100). Percentage recovery compared to their preinjury functional level averaged 91.4% (range, 40%-100%). There were no complications in this series. Twenty-two patients underwent screw removal electively at an average of 6.9 months following the index procedure. No patients had undergone any additional operative procedures, or had any objective evidence of midfoot collapse or arthritis at the time of final follow-up.

Minimally invasive methods of treating low-energy Lisfranc injuries with less soft tissue stripping and disruption, as described in this series, were a valuable tool to optimize outcomes while minimizing the potential morbidity of more traditional, open techniques.

Level IV, retrospective case series.