Pediatric and adolescent Lisfranc injuries - Presentation, treatment and outcomes

Lisfranc fracture dislocations are rare injuries and even more so in the pediatric population. The main purpose of our study is to present a descriptive analysis of Lisfranc injuries in pediatric patients to add to the current sparse literature on this topic. In addition, our secondary outcome was to analyze any differences in patients treated conservatively versus operatively, and those with isolated Lisfranc injuries versus those with associated foot injuries.

Charts of patients with Lisfranc injury treated at a tertiary pediatric hospital from January 2010 to July 2019 were reviewed to analyze their demographics, injury characteristics, management details and rehabilitation protocol. Functional outcome was assessed using the Visual Analogue Scale of Pain (VAS) and the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C).

30 patients/cases were included with mean age of 13.6 years and mean follow up of 36 weeks. 20% of the cases were missed on initial presentation. 19 cases were managed operatively while 11 were managed conservatively. The average OxAFQ-C and VAS pain scores were 83% and 1.3, respectively at mean follow-up of 36 weeks. The functional outcomes between conservative and operative cases or between those with isolated Lisfranc injuries and those with associated foot injuries were not statistically significant (p > 0.05).

Lisfranc injury in pediatrics can be easily missed. High index of suspicion, a thorough clinical examination and the use of advanced imaging is warranted. Various modalities like K-wires, screws and suture-buttons can be used for fixation. Early to mid-term functional outcomes are satisfactory provided that adequate reduction is obtained.