SLR - March 2019 - Dylan Roberg
Reference: Matthew T. Pigott, MD, Ronit Shah, BS , Jason Chan, MD, Todd A. Irwin, MD, James R. Holmes, MD, and Paul G. Talusan, MD. Initial Displacement Does Not Affect Loss of Reduction After Lisfranc Fracture Dislocations. Foot and Ankle Specialist. 2019 Jan 22.Scientific Literature Review
Reviewed By: Dylan Roberg, DPM
Residency Program: New York Presbyterian/Queens, Flushing, NY
Podiatric Relevance: Although uncommon injuries, Lisfranc fractures are an important topic, especially to the podiatric surgeon, as they are often misdiagnosed or missed completely. The importance of proper reduction of these fractures is well established in the literature; however, few articles have examined the postoperative recurrence rate of the dislocations, especially after hardware removal. This article examines whether a correlation exists between recurrence of displacement after open reduction and internal fixation of Lisfranc fractures relative to the severity of initial displacement.
Methods: A level II retrospective cohort was performed for all patients who underwent open reduction with internal fixation for Lisfranc fracture dislocations at a single institution between 2005 and 2014. A total of 45 patients were reviewed. Twenty-three sustained high-energy mechanism (displacement greater than or equal to 4 mm), and 25 suffered low-energy mechanisms (displacement less than 4 mm). Prospective outcomes were measured by radiographic evaluation of initial reduction and again at final follow-up (mean 32.1 months). All patients underwent hardware removal at three to 15 months after their initial procedure.
Results: Regardless of initial displacement, both groups had a high chance of initial anatomic reduction. At the time of final follow-up, a higher proportion of patients from the high displacement group had recurrent displacement, although this was not statistically significant ( P = .362). Additionally, there was no difference in rate of displacement at final follow-up between purely ligamentous injuries versus injuries with associated fractures.
Conclusions: There is no statistically significant difference in postoperative recurrence of displacement in high-energy versus low-energy Lisfranc fractures following ORIF. Limitations to this study include no control group in which initial hardware was left in place, variability in follow-up times and the use of multiple reduction and fixation techniques. Lisfranc dislocation recurrence rates are similar regardless of severity of initial injury or injury type, and they are a common occurrence despite initial anatomic reduction.