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Published on: November 8, 2024
358
Acute Lisfranc injury management
Freideriki Poutoglidou1, Bart van Groningen1, Louise McMenemy2
1Department of Trauma & Orthopaedics, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.
The Bone & Joint Journal
|November 30, 2024
Summary
Subtle Lisfranc injuries are common, requiring early diagnosis. A new stability-based system guides treatment, favoring nonoperative care for stable injuries and surgical fixation for severe ones, improving patient outcomes.
Area of Science:
- Orthopedic surgery
- Foot and ankle trauma
- Radiology
Background:
- Lisfranc injuries, or tarsometatarsal fracture-dislocations, are increasingly recognized due to advanced imaging.
- Injury patterns vary significantly in severity and anatomy, impacting treatment decisions.
- Traditional anatomy-based classifications have limitations in guiding effective management.
Purpose of the Study:
- To introduce a novel stability-based classification system for Lisfranc injuries.
- To review current evidence on diagnostic tools and treatment strategies.
- To guide optimal management for diverse Lisfranc injury patterns.
Main Methods:
- Review of current literature and evidence on Lisfranc injuries.
- Emphasis on weightbearing radiographs and CT scans for diagnosis.
- Analysis of outcomes for operative and nonoperative management strategies.
Main Results:
- A stability-based classification system is proposed, differentiating stable from unstable injuries.
- Stable injuries typically respond well to nonoperative management (immobilization, non-weightbearing).
- Displaced or comminuted injuries often require surgical intervention (ORIF, bridge plating).
Conclusions:
- Early diagnosis and a stability-based approach are crucial for optimal Lisfranc injury outcomes.
- Nonoperative care is effective for stable injuries; ORIF is common for unstable injuries.
- Further research is needed on novel fixation techniques and refining classification systems.
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