SURGICAL MANAGEMENT OF LISFRANC FRACTURE DISLOCATIONS USING DORSAL BRIDGE PLATING OF THE TARSOMETATARSAL JOINTS

Robert J MacFarlane, Ignatius Liew ,James Widnall , Andrew Molloy , Lyndon Mason

Background: Lisfranc ligament complex injuries are uncommon and frequently associated with high energy trauma. Dorsal bridge-plating has gained popularity in recent years as an alternative to transarticular screw fixation of the TMTJ’s. We present clinical outcomes and complications for dorsal bridge plating of Lisfranc fracture subluxations in a series of patients at our institution.

Methods: A retrospective casenote and radiographic review of all cases with Lisfranc injuries presenting to a major trauma centre in a 5 year period. Follow up was at 2 weeks, for wound review and plaster change, then 6 and 12 weeks, and every 6 months. Clinical outcomes using Manchester-Oxford foot&ankle questionnaire, EQ-5D and VAS pain scores were obtained.

Results: There were 18 male and 12 female patients. Male:female ratio was 3:2. The mean age was 41 years (range 16-70). Mean total follow up time was 336 days (range 50 to 1269 days). Mean length of follow up was 47 weeks (range 7 -147). Mean time to surgery was 11 days (range 0-24). 23% of patients were admitted as a major trauma activation. Mean time to union was 8 weeks (range 6-12). 9 required removal of hardware, 2 required injections, and 2 required fusion. There 6 complications, including CRPS (1 case), and persistent pain in 5 cases. 12/19 cases returned to work (63%) at a mean time of 28 weeks (range 18-60). The mean final MOXFQ sore was 33.5 (range 21.2-39.6). Mean final VAS pain score was 5.5 (range 1-8).

Conclusions: Previous studies have reported the results of several different surgical treatment methods, principally including primary arthrodesis and internal fixation. The present study compares favourably with recent reports for dorsal plating of TMTJ.

Implications: This study provides useful evidence for the use of dorsal bridge plating in complex midfoot injuries associated with high energy trauma.