Functional Outcomes of Dorsal Bridge Plating for Lisfranc Injuries with Routine Metalwork Retention: A Major Trauma Centre Experience

• Published in: Foot & ankle orthopaedics 2022-01, Vol.7 (1), p.2473011421S00383
• Main Authors: Onochie, Elliot I., Bua, Nelson, Patel, Amit, Jha, Shilpa, Heidari, Nima, Vris, Alexandros, Parker, Lee, Romans, Francesc Malagelada, Jeyaseelan, Luckshmana A.
• Format: Article
• Language: English
• Subjects: Injuries; Patients; Trauma
• ISSN: 2473-0114; 2473-0114
• DOI: 10.1177/2473011421S00383

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Lisfranc injuries represent a significant disruption to the complex articulations of the midfoot. Many of these injuries are unstable with displacement and articular incongruity. This necessitates surgical intervention with the primary goals of anatomic reduction and midfoot stability. Evidence around surgical treatments for Lisfranc complex injuries is limited by heterogeneity in outcome measures and small patient numbers. Dorsal bridge plating is a well-recognized surgical technique with the benefits of rigid stability and joint preservation. The primary aim of this study is to assess the midterm functional outcomes for patients treated with this technique at our major trauma centre. Additionally, we assess the complication profile and review for risk factors that influence the functional outcome. Methods: Eighty-five adult patients were identified as undergoing open reduction and dorsal bridge plate fixation for displaced, unstable Lisfranc injuries at our major trauma centre between January 2014 and January 2018. Supplemental Kirschner wire stabilization was used for the lateral column if necessitated by the injury pattern. Importantly, metalwork was not routinely removed. A retrospective review of case notes and imaging was conducted in order to collate demographic data including co- morbidities and smoking status. Patient-reported outcome measures were collected at final follow-up, with a minimum follow-up of 24 months. The Manchester-Oxford Foot Questionnaire summary index (MOXFQ-Index) was the primary patient-reported outcome. The American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scale, complications, and all-cause re-operation rates were secondary outcome measures. Univariate and multivariate analyses were used to identify risk factors associated with poorer functional outcomes. Results: The mean follow-up in this study was 40.8 months (24 - 72). 61/85 patients (72%) had high-energy or crush mechanisms of injury. The mean MOXFQ-Index was 27.0 (SD 7.1). The mean AOFAS score was 72.6 (SD 11.6). 48/85 patients (56%) had injury patterns that included an intra-articular fracture and this was associated with poorer outcomes, with worse MOXFQ and AOFAS scores (both p