Lisfranc complex injuries management and treatment: current knowledge.

Area of Science:

• Orthopedics and Sports Medicine
• Trauma Surgery
• Foot and Ankle Surgery

Background:

• Lisfranc complex injuries involve midfoot and tarsometatarsal joint trauma, ranging from ligamentous sprains to fracture-dislocations.
• Delayed or missed diagnoses, particularly in low-energy injuries, can lead to severe complications like post-traumatic osteoarthritis and foot deformities.
• Clinical presentation includes midfoot swelling, pain, instability, and characteristic plantar ecchymosis.

Purpose of the Study:

• To review the diagnosis, management, and treatment controversies of Lisfranc complex injuries.
• To emphasize the importance of early and accurate diagnosis for optimizing patient outcomes.
• To discuss various surgical and conservative treatment modalities and their impact on functional recovery.

Main Methods:

• Diagnostic imaging includes X-rays (3 projections), CT scans for subtle fractures/dislocations, and MRI as the gold standard for ligamentous injuries.
• Conservative management involves immobilization and non-weight-bearing for 6 weeks in stable, non-displaced injuries.
• Surgical treatment for displaced injuries focuses on anatomical reduction and stabilization of tarsometatarsal joints using techniques like ORIF, EF, or primary arthrodesis.

Main Results:

• Accurate diagnosis is crucial, as up to 20% of Lisfranc fractures are missed or delayed, often mistaken for simple sprains.
• Post-operative outcomes are primarily determined by the achievement of anatomical reduction, rather than the specific surgical technique employed.
• Injury severity and prompt diagnosis are the most significant factors influencing long-term biomechanical and functional results.

Conclusions:

• Early and precise diagnosis of Lisfranc injuries is paramount to prevent debilitating long-term sequelae.
• While various surgical techniques exist for displaced injuries, anatomical reduction is the critical determinant of successful treatment.
• Conservative management is suitable for stable lesions, while displaced injuries necessitate surgical intervention focused on joint restoration.