eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Lisfranc Fracture Dislocation: Follow-up

Author: Saul G Trevino, MD, Professor of Clinical Orthopedic Surgery, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine
Coauthor(s): Allison M Wade, MD, Fellow, Penn State Bone and Joint Institute, Penn State University Milton S Hershey Medical Center, Hershey, PA; John S Early, MD, Foot/Ankle Specialist, Texas Orthopaedic Associates, LLP; Co-Director, North Texas Foot and Ankle Fellowship Baylor University Medical Center; Santaram Vallurupalli, MD, Research Resident, Department of Orthopedic Surgery, University of Missouri at Columbia
Contributor Information and Disclosures

Updated: Oct 6, 2009

Outcome and Prognosis

Stable anatomic alignment is the best predictor of outcome. The presence of fractures and/or articular destruction leads to poorer results, regardless of alignment. Incidence of posttraumatic arthritis reportedly ranges from 0-58%.20  One study reported that up to 25% of patients develop posttraumatic arthritis even after fixation. This same study showed that there was no difference between acute and delayed (>6 weeks) surgical fixation. Purely ligamentous injuries seemed to have poorer outcomes.  Good results are achieved with open reduction and internal fixation (ORIF) at up to 6 weeks, but poor outcomes are seen after this time due to articular destruction, malalignment, and poor soft-tissue envelope.

Future and Controversies

Role of acute fusion

Stability at this joint level of the foot is the primary concern, and instability appears to be the primary pain generator. Primary fusion of the medial 3 TMT joints has been advocated due to the unpredictability of adequate ligamentous healing to support the foot.

In 2006, Ly and colleagues reported the results of their study comparing primary arthrodesis with ORIF in primarily ligamentous Lisfranc injuries.21,22 Twenty patients were treated with ORIF, and 21 were treated with arthrodesis of the medial 2 or 3 TMT joints, with an average follow-up period of 42.5 months. Using outcome measures, the authors reported that the members of the arthrodesis group reached a postoperative activity level that was an estimated 92% of their pre-injury activity level, while in the ORIF group, members achieved an activity level that was only 65% of their pre-injury level. The authors concluded that a stable, primary arthrodesis seemed to have better short- and medium-term outcomes. Whether this improves long-term results is not yet known.

Length of time before screw removal

Suggestions of length of time that screws should remain in place range from 6 weeks to 3 months after weight bearing begins (up to 6 months from the time of surgery). Results demonstrate that if fixation screws remain in place indefinitely, they have a high tendency to break with time, thereby causing pain. If the joint is not fused purposely during surgery, then some motion is expected; this constant motion causes hardware failure.

The timing of screw removal remains a question. Advocates of early removal stress the fear of early screw failure as the main reason for removal. Others believe that the screws should remain in place even during early weight bearing to slowly help condition the damaged ligaments to resume supporting the foot. Long-term follow-up is needed before this issue can be resolved.

Use of different bio-absorbable materials

The advantage of using different bio-absorbable materials to provide short-term stability following surgical reduction is that no screws need to be removed. Issues are 2-fold:

  • What effect do degradation products have on joint chemistry?
  • Is the sheer strength of bio-absorbable screws sufficient to maintain the reduction in this situation?
In 2002, Thordarson and colleagues reported results from 14 patients at an average follow-up of 20 months. At this short-term follow-up they determined that bio-absorbable screws are safe and that they eliminate the need for screw removal. Larger studies with long-term follow-up are needed to determine the true efficacy.23

 


More on Lisfranc Fracture Dislocation

Overview: Lisfranc Fracture Dislocation
Workup: Lisfranc Fracture Dislocation
Treatment: Lisfranc Fracture Dislocation
Follow-up: Lisfranc Fracture Dislocation
Multimedia: Lisfranc Fracture Dislocation
References
Further Reading
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References

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Keywords

tarsometatarsal injuries, TMT injuries, Lisfranc dislocation, Lisfranc injury, midfoot injury, Lisfranc ligament, open reduction and internal fixation, ORIF

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Contributor Information and Disclosures

Author

Saul G Trevino, MD, Professor of Clinical Orthopedic Surgery, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine
Saul G Trevino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Clinical Orthopaedic Society, Mid-America Orthopaedic Association, Phi Beta Kappa, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Allison M Wade, MD, Fellow, Penn State Bone and Joint Institute, Penn State University Milton S Hershey Medical Center, Hershey, PA
Allison M Wade, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Mid-America Orthopaedic Association, Southern Orthopaedic Association, and Tennessee Medical Association
Disclosure: Nothing to disclose.

John S Early, MD, Foot/Ankle Specialist, Texas Orthopaedic Associates, LLP; Co-Director, North Texas Foot and Ankle Fellowship Baylor University Medical Center
John S Early, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, and Texas Medical Association
Disclosure: Zimmer Inc Consulting fee Consulting; Smith Nephew Consulting fee Consulting; AO North America Honoraria Speaking and teaching; Osteotech Consulting fee Consulting; Stryker Consulting fee Consulting

Santaram Vallurupalli, MD, Research Resident, Department of Orthopedic Surgery, University of Missouri at Columbia
Disclosure: Nothing to disclose.

Medical Editor

James K DeOrio, MD, Director of Foot and Ankle Fellowship Program, Assistant Professor of Orthopedic Surgery, Orthopedic Surgery, St Lukes Hospital, Jacksonville, Florida
James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Florida Medical Association, and German Society of Neurology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

 
 
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