Outcomes after nonoperatively treated non-displaced Lisfranc injury: a retrospective case series of 55 patients
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TRAUMA SURGERY
Outcomes after nonoperatively treated non‑displaced Lisfranc injury: a retrospective case series of 55 patients Ville T. Ponkilainen1,4 · Nikke Partio1 · Essi E. Salonen1 · Heikki‑Jussi Laine2 · Heikki M. Mäenpää1 · Ville M. Mattila1,3 · Heidi H. Haapasalo1 Received: 19 February 2020 / Accepted: 9 September 2020 © The Author(s) 2020
Abstract Background Current knowledge of the role of the nonoperative treatment of Lisfranc injuries is based on a few retrospective case series. Hence, consensus on which patients can be treated nonoperatively does not exist. The aim of this study was to investigate outcomes after nonoperative treatment of Lisfranc injuries. Methods In this study, patients were collected by recruiting all computer tomography-confirmed Lisfranc injuries treated during a 5-year period at a major trauma hospital. Between 2 and 6 years after suffering the injury, patients completed the visual analogue scale foot and ankle questionnaire. Results In total, 55 patients returned adequately completed questionnaires and were included in the study. Of those, 22 patients had avulsion fractures and 33 had simple non-displaced intra-articular fractures. Of these patients, 30 (55%) scored over 90 points in both the pain and function subscales of the VAS-FA, and 35 (64%) scored over 90 points overall. In addition, three (5%) patients scored under 60 points in both the pain and function subscales of the VAS-FA, and four (7%) scored under 60 points overall. Only one patient with avulsion fractures underwent secondary surgery. Conclusion Nonoperative treatment has a role in the treatment of Lisfranc injuries, and the results of our study support the view that avulsion and simple intra-articular fractures with < 2 mm of displacement can be treated nonoperatively with high functional outcomes. The results of nonoperative and operative treatment should be compared in a prospective randomized controlled study setting in future studies. Level of evidence IV, retrospective case series Keywords Lisfranc · Injury · Tarsometatarsal · Nonoperative · Conservative · Treatment · Outcomes
Introduction The ‘Lisfranc injury’ comprises a broad spectrum of tarsometatarsal (TMT) joint injuries that range from subtle injuries to complete dislocation [13, 20, 22, 28]. The incidence of these injuries has been found to be more common * Ville T. Ponkilainen [email protected] 1
Department of Orthopaedics, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Teiskontie 35, PL2000, 33521 Tampere, Finland
2
Pohjola Sairaala, Kelloportinkatu 1, 33100 Tampere, Finland
3
COXA Hospital for Joint Replacement, Biokatu 6, 33520 Tampere, Finland
4
University of Tampere, School of Medicine, 33520 Tampere, Finland
(9.2/100,000/person years) than previously thought, and more subtle injuries are found nowadays due to more precise diagnostics [25]. The first studies investigating Lisfranc fracture dislocations, published before 1990, consecutively recommended operative t
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