Closed Reduction and Percutaneous Fixation of Lisfranc Injury Using Suspensory Fixation

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Reconstruction
• Trauma Surgery

Background:

• Lisfranc injuries involve the tarsometatarsal joint complex, often resulting from low-energy trauma.
• Displaced or unstable Lisfranc injuries require prompt treatment to prevent midfoot collapse and arthritis.
• Traditional treatments like open reduction and internal fixation (ORIF) and primary arthrodesis carry significant risks.

Purpose of the Study:

• To describe the technique of closed reduction and percutaneous fixation (CRPF) with suspensory fixation for Lisfranc injuries.
• To evaluate the benefits of CRPF with suspensory fixation over ORIF, primary arthrodesis, and percutaneous reduction and internal fixation (PRIF) with screws.
• To outline the expected outcomes and postoperative management following CRPF with suspensory fixation.

Main Methods:

• Patient positioning in supine with fluoroscopic stress examination.
• Closed reduction of the Lisfranc joint, maintained with a clamp.
• Percutaneous guidewire insertion followed by cannulated drilling and suspensory fixation with suture buttons and a bioabsorbable screw.

Main Results:

• CRPF with suspensory fixation minimizes soft-tissue trauma, reducing risks of infection and wound complications compared to ORIF.
• This technique allows for earlier rehabilitation and improved range of motion compared to PRIF with screws.
• Studies show comparable fixation stability and clinical outcomes to PRIF, with fewer complications related to hardware irritation or breakage.

Conclusions:

• CRPF with suspensory fixation is a safe and effective technique for treating specific Lisfranc injuries.
• It offers advantages over traditional ORIF and primary arthrodesis, as well as PRIF with screws, including reduced soft-tissue disruption and improved functional recovery.
• Patients can typically return to full activity within 12-16 weeks postoperatively.