Initial Displacement Does Not Impact Loss of Reduction After Lisfranc Fracture-Dislocations
Author(s):
Pigott M. (United States of America)
,
Pigott M. (United States of America)
Affiliations:
Chan J.
,
Chan J.
Affiliations:
Irwin T.
,
Irwin T.
Affiliations:
Holmes J.
,
Holmes J.
Affiliations:
Talusan P.
Talusan P.
Affiliations:
ESSKA Academy. Pigott M. 05/09/18; 209228; P01-324 Topic: Open Surgery
Matthew Pigott
Matthew Pigott
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Abstract
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Objectives: The purpose of this study was to determine whether the soft tissue injury associated with high initial displacement of Lisfranc injuries had a significant impact on loss of reduction after open reduction and internal fixation of these injuries.

Methods: All skeletally mature patients who underwent open reduction and internal fixation (ORIF) of an acute Lisfranc injury from 2005 to 2015 were found by searching CPT codes and verifying via chart and radiograph review. Those patients with polytrauma, open fractures, or previous foot surgery were excluded. Injury plain films, immediate post-surgical films, and 6 month follow up films were reviewed for their reduction using the following criteria previously described in the literature: 1. Medial border of the second metatarsal with the medial border of the middle cuneiform on the AP, 2. Medial border of the fourth metatarsal with the medial border of the cuboid on the oblique, and 3. An unbroken line between the cuneiforms and metatarsals on the lateral. Maximum displacement on the injury films was recorded as well as the displacement both immediately after surgery and 6 months postoperative.

Results: 248 cases were initially identified by database query. Of those, 105 survived inclusion and exclusion criteria. 45 patients had a minimum of 6 months of postoperative follow up and were included. Average initial displacement was 4.2mm (0-18.5mm). Anatomic reduction was achieved immediately postoperative in 89% of cases. Those patients with high initial displacement ( ≥ 4mm) did not have an increased rate of loss of reduction compared to those patients with low initial displacement (<4mm, p=0.362). We found that only one person went on to develop osteoarthritis severe enough to undergo fusion of her Lisfranc joint 32 months after her initial ORIF.

Conclusions: Our results demonstrate that a high degree of displacement in Lisfranc injuries does not preclude achievement and maintenance of adequate reduction after ORIF of these injuries. We also found only one person who did poorly enough to undergo fusion after ORIF. These results suggest that even severe injuries may be adequately treated with ORIF.

Keywords:
Lisfranc, Reduction, Displacement, Fixation, Outcomes
Objectives: The purpose of this study was to determine whether the soft tissue injury associated with high initial displacement of Lisfranc injuries had a significant impact on loss of reduction after open reduction and internal fixation of these injuries.

Methods: All skeletally mature patients who underwent open reduction and internal fixation (ORIF) of an acute Lisfranc injury from 2005 to 2015 were found by searching CPT codes and verifying via chart and radiograph review. Those patients with polytrauma, open fractures, or previous foot surgery were excluded. Injury plain films, immediate post-surgical films, and 6 month follow up films were reviewed for their reduction using the following criteria previously described in the literature: 1. Medial border of the second metatarsal with the medial border of the middle cuneiform on the AP, 2. Medial border of the fourth metatarsal with the medial border of the cuboid on the oblique, and 3. An unbroken line between the cuneiforms and metatarsals on the lateral. Maximum displacement on the injury films was recorded as well as the displacement both immediately after surgery and 6 months postoperative.

Results: 248 cases were initially identified by database query. Of those, 105 survived inclusion and exclusion criteria. 45 patients had a minimum of 6 months of postoperative follow up and were included. Average initial displacement was 4.2mm (0-18.5mm). Anatomic reduction was achieved immediately postoperative in 89% of cases. Those patients with high initial displacement ( ≥ 4mm) did not have an increased rate of loss of reduction compared to those patients with low initial displacement (<4mm, p=0.362). We found that only one person went on to develop osteoarthritis severe enough to undergo fusion of her Lisfranc joint 32 months after her initial ORIF.

Conclusions: Our results demonstrate that a high degree of displacement in Lisfranc injuries does not preclude achievement and maintenance of adequate reduction after ORIF of these injuries. We also found only one person who did poorly enough to undergo fusion after ORIF. These results suggest that even severe injuries may be adequately treated with ORIF.

Keywords:
Lisfranc, Reduction, Displacement, Fixation, Outcomes
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