Outcomes of primary fusion in high-energy Lisfranc injuries at a tertiary state hospital

Background: High-energy Lisfranc injuries are relatively uncommon but can lead to severe disability and morbidity. Primary fusion is a treatment option that can improve outcomes and reduce the reoperation rate. The aim of this study was to evaluate our series of primary fusions for high-energy Lisfranc injuries, looking specifically at type of fusion, time to union, non-union rates, reoperation rates and quality of reduction. Methods: Patients who underwent surgery for Lisfranc injuries were identified from the REDCap surgical database and then retrieved from records. Only cases of primary fusion in adults were included. We excluded low-energy sprains and athletic injuries, ipsilateral lower limb injuries and cases where reduction and fixation were done. Radiographs were analysed from the iSite Enterprise PACS system (Philips®). Results: Between 2013 and 2018, 12 cases of high-energy Lisfranc injuries were identified where primary fusion was done. Seven patients (58%) underwent fusion of the first, second and third tarsometatarsal (TMT) joints. The first and second TMT joints were fused in only one case (8%), and the second and third TMT joints were fused in four cases (33%). Only one patient (8%) had removal of implants. Compression plating was the technique of choice used for fusion. There was 100% union rate and average time to union was 84 days. Acceptable reduction was observed in nine cases (75%). Three cases (25%) of malreduction were found, among which one patient had pre-existing hallux valgus. Conclusion: The majority of patients who underwent primary fusion of at least one TMT joint had good radiological outcome. Further studies with better clinical follow-up are needed. Level of evidence: Level 4