SLR - June 2023 - Navdeep Bains, DPM
Title: Management of Lisfranc Injuries: A Critical Analysis reviewReference: Carter, T. , Heinz, N. , Duckworth, A. , White, T. & Amin, A. (2023). Management of Lisfranc Injuries. JBJS Reviews, 11 (4), doi: 10.2106/JBJS.RVW.22.00239.
Level of Evidence: IV
Scientific Literature Review
Reviewed By: Navdeep Bains, DPM
Residency Program: New York Presbyterian Queens, Flushing, NY
Podiatric Relevance: Lisfranc injuries are encountered by every podiatrist whether in the emergency room setting after a polytrauma injury, or in the clinic setting after injury while working or playing sports. Identification, management, and treatment of Lisfranc injuries is crucial for a podiatric surgeon. This article reviews the anatomy, presentation, and diagnosis of Lisfranc injuries, as well as overview of the treatment.
Methods: In this critical analysis, review of the literature over the past decade was performed. Findings related to anatomy, clinical presentation, radiographic investigation, and treatment of Lisfranc injuries were summarized.
Results: The Lisfranc ligament is made of 3 components; dorsal, interosseous, and plantar. Both low and high energy mechanisms of injury have been identified. Non-weight bearing radiographs are the primary imaging modality followed by bilateral weight bearing radiographs or CT/MRI if the patient is unable to bear weight. For Lisfranc sprains and minimally displaced injuries non-operative treatment with non-weight bearing casting for 4-6 weeks is appropriate management. Operative management options include percutaneous fixation, ORIF, and primary arthrodesis based on the severity of injury, with anatomic reduction and stable fixation being most important for satisfactory outcome. Based on 6 published meta-analyses, hardware removal is less frequent after primary arthrodesis compared to ORIF.
Conclusions: This article concluded Lisfranc injuries vary in presentation and management options. Through their analysis, they developed a management algorithm to help guide providers. Radiographic identification is essentially the key step in management as subtle injuries can be quite easily missed. It is important to fully evaluate patients with midfoot pain and rule out Lisfranc injury based on mechanism of injury and with weight bearing radiographs, CT, or MRI when non-weight bearing radiographs are inconclusive. It is vital to take serial radiographs when treating a patient non-operatively to ensure the Lisfranc joint remains in adequate alignment. For operative management, percutaneous fixation is sufficient if adequate reduction can be achieved percutaneously. ORIF and primary arthrodesis are both adequate treatment options depending on the level of articular involvement, with the key being adequate reduction and stable fixation. Further studies need to be done to determine functional outcomes of primary arthrodesis vs ORIF in young active patients.