Occupational Outcomes and Return to Running After Operative Management of Lisfranc Injuries in a High-Demand Population

• Published in: Foot and ankle specialist 2022-02, Vol.15 (1), p.18-26
• Main Authors: Koehler, Logan, Waterman, Brian R., Kusnezov, Nicholas A., Blair, James A., Belmont, Philip J., Orr, Justin D.
• Format: Article
• Language: English
• Subjects: Adult; Arthrodesis; Fracture Dislocation; Fracture Fixation, Internal; Humans; Open Fracture Reduction; Retrospective Studies; Running; Treatment Outcome
• ISSN: 1938-6400; 1938-7636
• DOI: 10.1177/1938640020933078

Background: Literature evaluating outcomes following operative fixation of Lisfranc injuries has demonstrated high rates of chronic disability, particularly in those returning to prior levels of physical function. The purpose of this study is to evaluate the occupational outcomes and return to running after open reduction and internal fixation (ORIF) or arthrodesis for Lisfranc fracture-dislocations in a moderate- to high-demand military cohort. Methods: All active-duty servicemembers undergoing ORIF or primary arthrodesis (Current Procedural Terminology 28615 and 28730, respectively) for confirmed Lisfranc fracture-dislocations (International Classification of Diseases, Ninth Revision codes 838.03 or 838.13) with minimum 2-year follow-up were isolated from the Military Health System. Demographic and surgical variables were recorded. Return to military function, return to running, perioperative morbidity, and rates of reoperation for complication were the outcomes of interest. Univariate analysis followed by multivariate logistic regression determined the association between patient demographics, type of fracture fixation (ie, ORIF vs arthrodesis) and functional outcomes, including medical separation. Results: Among Lisfranc injuries, 64 patients underwent ORIF while 6 underwent primary arthrodeses with a mean age of 28.1 years. At mean follow-up of 3.5 years (range, 2.0-6.3 years), 20% of servicemembers underwent medical separation due to limitations related to their injuries. body mass index (BMI) ≥30 kg/m2 (OR 17.67; 95% CI, 3.69-84.53) and Army or Marines service branch (OR 3.86; 95% CI, 1.08-13.86) were significant independent predictors for medical separation. Among servicemembers undergoing ORIF or primary arthrodeses, 69% returned to occupationally required daily running during the follow-up period. Servicemembers with a BMI