Percutaneous Treatment with Bridge Plate in Low-Energy and High-Energy Lisfranc Injuries

Category: Trauma; Other Introduction/Purpose: Although there is still no consensus regarding the optimal treatment approach to both high and subtle Lisfranc injuries, and even when achieving both anatomic reduction and joint complex alignment restoration, percentages of secondary osteoarthritis remain high. Besides the initial chondral damage, the perforation of the different articular facets, necessary for stabilization with position screws, could also influence the articular degeneration evolution. This work aims to show the clinical and radiographic results of a prospective patient cohort followed over three years, obtained by indirect reduction and percutaneous fixation with bridge plate and extraarticular screws in both subtle and high-energy Lisfranc injuries. Methods: A prospective, observational, cross-sectional study of 27 consecutive Lisfranc patients was carried out. Upon diagnosis, patients underwent percutaneous plate and extraarticular screw fixation. Quality of reduction was considered “anatomical” when no diastasis was observed between the first and second metatarsal bases, “almost anatomical” with less than 2 mm of incongruence present, and “non-anatomical” if incongruence was greater than 2 mm. AOFAS midfoot score was utilized for clinical evaluation. Results: 27 patients with a mean age of 31.1 years and a mean follow-up was 35.5 months were analyzed. 17 sustained high-energy lesions while 10 presented low-energy injuries. The postoperative AOFAS score at the final follow-up was 81 points. Patients with an increased number of columns affected, evident unstable Lisfranc injuries, increased age, or staged procedures were associated with lower AOFAS scores. Global quality of reduction positively correlates with the AOFAS score, although no statistically significant association between the number of columns affected and the quality of reduction achieved by this technique was observed. 4 of 27 patients progressed to osteoarthritis and one of them needed further arthrodesis at less than a year after the procedure. No patient presented major wound-related complications. Conclusion: We perform fixation with plates via proximal and distal portals. To serve the purpose of being less possibly aggressive with the joint, screws could be avoided, except for the one necessary to restore the position of the second metatarsal base and the first cuneiform. In this series patients with high-energy injuries depicted good functional results with a high percentage of anatomical reductions over time, with no statistical differences from the low-energy group. The lesser manipulation of the soft tissues needed is probably one of the reasons for the low percentage (7 %) of surgical site infections we report.