SLR - January 2023 - Kalen Farr, DPM, PGY-3
Title: Functional Outcomes of Dorsal Bridge Plating For Lisfranc Injuries with Routine Implant Retention: A Major Trauma Center ExperienceReference: Onochie E, Bua N, Mmerem K, et al. Functional Outcomes of Dorsal Bridge Plating For Lisfranc Injuries with Routine Implant Retention: A Major Trauma Center Experience. J Orthop Trauma. 2022 Aug 9; 10.
Level of Evidence: Level IV
Scientific Literature Review
Reviewed By: Kalen Farr, DPM, PGY-3
Residency Program:SSM Health DePaul Hospital, Bridgeton, MO
Podiatric Relevance: Several different fixation options exist for Lisfranc ORIF, and this is an injury podiatrists frequently encounter in their practice. Occasionally, physicians find themselves needing to remove previously implanted hardware for a variety of reasons. This article demonstrates a detailed analysis of patient recorded outcome measures (PROM) regarding implant retention for dorsal bridge plating (DBP) for displaced Lisfranc injuries.
Methods: A retrospective case series was performed evaluating patient who underwent ORIF with DBP in displaced Lisfranc fractures. Inclusion criteria rendered patients eligible with an acute displaced Lisfranc injury with ORIF with DBF surgery performed within 2 weeks, skeletal maturity, and a 24 month follow-up. Exclusion criteria included open fractures, previous ipsilateral foot surgery, ipsi/contralateral lower limb injury, polytrauma, and incomplete documentation. Injuries were categorized utilizing plain radiographs and CT imaging based on Myerson, and Quenu and Kuss classification systems, distinguishing purely ligamentous, from intra-articular and extra articular fractures. PROM were evaluated utilizing the Manchester-Oxford Foot Questionaire Summary Index (MOXFQ-Index) primarily and American Orthopedic Foot and Ankle Society (AOFAS) midfoot scale secondarily.
Results: 85 patients met the inclusion criteria for this study with the most common fixation of these patients was DBP of TMTJ 1-3 (41 patients) with 9 others require percutaneous k-wire fixation of the lateral column. The mean MOXFQ score was 27.0 (16-43) +/- 7.1. The mean AOFAS score was 72.6 (47-89) +/- 11.6. Both scales noted a worse outcome with intra-articular fractures. Regarding complications, 5 patients (6%) underwent complications with two in the form of superficial infections resolved with antibiotics, two developing CRPS, and one with a broken screw. 18 patients (21.2%) required hardware removal due to soft tissue irritation. The odds of implant removal were 3 times higher in the female population presented. 8 patients (9.4%) also went on to require secondary arthrodesis.
Conclusions: The authors of this study concluded that DBP fixation for Lisfranc injuries can offer good medium term outcomes but with limitations as intra-articular fractures are a significant indicator of a poor prognosis. 1 in 5 patients are likely to require hardware removal with a larger propensity for women. It is important to make note of the type of injury sustained when evaluating these patients for treatment, as this study demonstrates favorable outcomes utilizing DBP in the majority, but exhibits significantly worse PROM scores when dealing with intra-articular fractures, indicating dorsal bridge plating or possibly even ORIF may not be an appropriate treatment in that setting. This opens the door for potential future research regarding fixation options for the different varieties of displaced Lisfranc injuries.