Functional outcome of percutaneous k-wire fixation in lisfranc injuries

Background: Lisfranc injuries, characterized by fractures and dislocations of the tarso-metatarsal joints, pose significant challenges in orthopaedic management. This study presents the effective use of percutaneous K-wire fixation in a patient with a Lisfranc fracture-dislocation. The aim is to discuss the methodology, outcomes, and implications of percutaneous k wire fixation in lisfranc injuries. Introduction: ‘Lisfranc injury’ defines an injury in which one or more of the metatarsals are displaced with respect to the tarsal. The term Lisfranc injury is very broad and refers to a low-energy sports injury to a high-energy lesion like road traffic accident, as well as injury comprising only ligamentous or those, which are associated with fractures of the metatarsals, cuneiform or cuboid bone. Diagnosing this type of injury early and accurately are fundamental requirements for their appropriate management and to prevent long-term complications. Early reductions and stable fixation without soft tissue compromise provides optimal results. Aims & Objectives: To study the functional outcome of Lisfranc injury treated with percutaneous k-wire fixation after a follow up of minimum period of 6 months using AOFAS midfoot score. Methods: A prospective observational study was conducted at the Department of Orthopaedics, SMIMER Hospital, Surat during the period January 2024 to December 2024. 15 patients of 20-70 years, who underwent percutaneous k wire fixation for Lisfranc injury were followed up. Functional outcomes at two months to one year follow up were evaluated based on validated questionnaire ‘AOFAS midfoot score’. Results: Most of the patients were between age group of 31 to 40 with mean age 38.8 (SD±1.2). In the study 9 were males (60%) and 6 (40%) were females. Road traffic accidents (RTA) was the mode of injury for 10 patients (66.67%). 3 (20%) sustained injuries due to fall from height and 2 (13.33%) due to crush injury. 3 patients (20%) had open fractures and 12 (80%) had closed injury. Anatomical reduction was obtained in 12 patients (80%). Post-operative arthritis was seen in 2 patients (13.33%), implant failure in 1 (6.67%) and none of our patient needed a second surgery. The mean AOFAS mid foot score was 88.4 (SD±1.62). 14 (93.33%) patients had good score ≥60. Conclusion: The study with percutaneous k wire fixation for lisfranc injury showed good functional outcome. Our results support the concept that percutaneous or minimally invasive fixation after anatomical reduction of fracture-dislocations of the Lisfranc injury leads to the better long-term outcomes with minimal wound complications. Though it was not free of complications, this study has shown good results. Further detailed long term studies and clinical trials are required to evaluate the validity of percutaneous k wire for the treatment of Lisfranc injuries.