Lisfranc fracture dislocations: percutaneous reduction and fixation using screws

S. Agarwal, E. Iliopoulos, A. Khaleel

Aim: Anatomical reduction and Stable fixation of Lisfranc injuries is considered the gold standard. There is controversy about how it is best achieved. Some surgeons would advocate routine open anatomical reduction, which as a concept was popular in 1980s but the same anatomical reduction and fixation can be achieved percutaneously. We describe our method of close reduction and percutaneous fixation and present our results.

Materials and methods: 22 patients with a minimum follow up of 12 months were included. We achieved satisfactory anatomical reduction percutaneously in all patients and internal fixation was performed using cannulated screws for medial and middle columns. Functional outcome was evaluated using Foot and Ankle Disability Index (FADI) and components of this score were analysed individually to assess which domain was most affected. Vertical ground reaction forces were measured using a force plate in a walking platform.

Results: The average age at operation was 48 years (17-67). Mean follow up was 20 months (13-60). The average Foot & Ankle Disability Index at final follow up was 79 (66-94). No loss of reduction or metal breakage was noted. Walking on uneven surface, going down stairs, heavy work and pain first thing in the morning were the domains of functional Index that showed poor recovery. None of the patients had pain at rest. Only three patients found it extremely hard to return to recreational activities. None of the patients had problems related to wound. Gait analysis showed a prolonged push-off (p=0.22) and significantly prolonged pre-swing phase (p=0.015) of the affected limb.

Conclusions: Percutaneous reduction and fixation technique for Lisfranc injuries provides predicatable good functional outcome and gait pattern similar to open tecchinques with a potentially decreased risk of wound problems.