Complications and Outcomes After Fixation of Lisfranc Injuries at an Urban Level 1 Trauma Center.

Abstract

Objectives: To evaluate patients with tarsometatarsal fractures and dislocations and describe complications and secondary operations.

Methods:

Design: Retrospective cohort study.

Setting: Level 1 trauma center.

Patient selection criteria: Consecutive adults treated acutely for Lisfranc injuries with reduction and fixation using standard techniques of rigid medial fixation and flexible lateral fixation.

Outcome measures and comparisons: Complications include infections, wound healing problems, nonunion, malunion, and posttraumatic arthrosis (PTA), and secondary unplanned procedures after a minimum of 2-year radiographic follow-up.

Results: Mean age of the included 118 patients was 40 years (range, 18-73 years) and 96 (74%) were male. Comorbidities included obesity (n = 32; 40%), diabetes mellitus (n = 12; 9%), and tobacco use (n = 67; 52%). Thirty (23%) were open injuries, and concomitant forefoot injuries were present in 47% and hindfoot injuries in 12%. Unplanned secondary procedures, including implant removals, were performed on 39 patients (33%), most often for removal of painful implants (26%) or infectious debridement (9%). Sixty-seven complications occurred, with PTA most frequent (37%). Deep infections occurred in 8%. On multivariate analysis, open injury ( P = 0.028, CI = 1.22-30.63, OR = 6.12) and concomitant forefoot injury ( P = 0.03, CI = 1.12-9.76, OR = 3.31) were independent risk factors for complication.

Conclusions: Open Lisfranc injuries were associated with complications, with deep infections occurring in 9%. Secondary procedures were most often performed for pain relief; the most common late complication was PTA, warranting counseling of patients about potential long-term sequelae of injury.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.