Skip to main content
SpringerLink
Log in

Factors influencing postoperative residual diastasis after the operative treatment of acute Lisfranc fracture dislocation

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Clinically, surgeons may frequently encounter residual diastasis between the medial cuneiform and 2nd metatarsal base after the operative treatment of acute Lisfranc fracture dislocations. The purpose of this study was to identify factors influencing postoperative residual diastasis. We specifically focused on the preoperative fracture pattern using 3-dimensional computed tomography (3D-CT).

Materials and methods

Radiographic and clinical findings of 66 patients who underwent operative treatment for acute Lisfranc fracture dislocation were reviewed. Patients were grouped according to residual diastasis evaluated by weight-bearing anteroposterior radiograph of the foot at the final follow-up. Residual diastasis was defined as distance between the medial cuneiform and 2nd metatarsal base greater than the distance on the contralateral side by 2 mm or more. Demographic parameters and fracture patterns based on preoperative foot 3D-CT were compared. A paired t test was used to compare continuous numeric parameters, while a Chi-square test was used for the proportional parameters. Statistical significance was set at P value less than 0.05 for all analyses.

Results

The mean age at operation, sex, body mass index, and the rate of underlying diabetes were not significantly different between the two groups (P > 0.05 each). Preoperative foot 3D-CT evaluation showed that the rate of large (> 25% of 2nd tarsometatarsal joint involvement), displaced (> 2 mm) fracture fragments on the plantar side of the 2nd metatarsal base was more pronounced in the group with residual diastasis (P = 0.001), while medial wall avulsion of the 2nd metatarsal base was more frequent in the group without residual diastasis (P = 0.001).

Conclusions

While treating acute Lisfranc injuries, surgeons should be aware of the presence of a 2nd metatarsal base plantar fracture. A dorsoplantar inter-fragmentary fixation can be considered if the fragment is large and displaced.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Aitken AP, Poulson D (1963) Dislocations of the tarsometatarsal joint. J Bone Jt Surg Am 45:246–260. https://doi.org/10.2106/00004623-196345020-00003

    Article  Google Scholar 

  2. Kalia V, Fishman EK, Carrino JA, Fayad LM (2012) Epidemiology, imaging, and treatment of Lisfranc fracture-dislocations revisited. Skelet Radiol 41:129–136. https://doi.org/10.1007/s00256-011-1131-5

    Article  Google Scholar 

  3. Lau S, Bozin M, Thillainadesan T (2017) Lisfranc fracture dislocation: a review of a commonly missed injury of the midfoot. Emerg Med J 34:52–56. https://doi.org/10.1136/emermed-2015-205317

    Article  PubMed  Google Scholar 

  4. Eleftheriou KI, Rosenfeld PF, Calder JDF (2013) Lisfranc injuries: an update. Knee Surg Sports Traumatol Arthrosc 21(6):1434–1446. https://doi.org/10.1007/s00167-013-2491-2

    Article  PubMed  Google Scholar 

  5. Ponkilainen VT, Partio N, Salonen EE, Laine H, Mäenpää HM, Mattila VM, Haapasalo HH (2020) Outcomes after nonoperatively treated non-displaced Lisfranc injury: a retrospective case series of 55 patients. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03599-w (Online ahead of print)

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lau S, Howells N, Millar M, De Villiers D, Joseph S, Oppy A (2016) Plates, screws, or combination? Radiologic outcomes after Lisfranc fracture dislocation. J Foot Ankle Surg 55(4):799–802. https://doi.org/10.1053/j.jfas.2016.03.002

    Article  PubMed  Google Scholar 

  7. Weglein DG, Andersen CR, Morris RP, Buford WL Jr, Panchbhavi VK (2015) Allograft reconstruction of the Lisfranc ligament. Foot Ankle Spec 8(4):292–296. https://doi.org/10.1177/1938640015584768

    Article  PubMed  Google Scholar 

  8. Panchbhavi VK, Vallurupalli S, Yang J, Andersen CR (2009) Screw fixation compared with suture-button fixation of isolated Lisfranc ligament injuries. J Bone Jt Surg Am 91(5):1143–1148. https://doi.org/10.2106/JBJS.H.00162

    Article  Google Scholar 

  9. Brin YS, Nyska M, Kish B (2010) Lisfranc injury repair with the TightRope device: a short-term case series. Foot Ankle Int 31(7):624–627. https://doi.org/10.3113/FAI.2010.0624

    Article  PubMed  Google Scholar 

  10. Seybold JD, Coetzee JC (2015) Lisfranc injuries: when to observe, fix, or fuse. Clin Sports Med 34(4):705–723. https://doi.org/10.1016/j.csm.2015.06.006

    Article  PubMed  Google Scholar 

  11. Briceno J, Leucht AK, Younger A, Veljkovic A (2020) Subtle Lisfranc injuries: fix it, fuse it, or bridge it? Foot Ankle Clin 25(4):711–726. https://doi.org/10.1016/j.fcl.2020.08.014

    Article  PubMed  Google Scholar 

  12. Hardcastle PH, Reschauer R, Kutscha-Lissberg E, Schoffmann W (1982) Injuries to the tarsometatarsal joint. Incidence, classification and treatment. J Bone Jt Surg Br 64(3):349–356. https://doi.org/10.1302/0301-620X.64B3.7096403

    Article  CAS  Google Scholar 

  13. Myerson MS, Fisher RT, Burgess AR, Kenzora JE (1986) Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle 6(5):225–242. https://doi.org/10.1177/107110078600600504

    Article  CAS  PubMed  Google Scholar 

  14. Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK (2007) Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg 46(2):65–74. https://doi.org/10.1053/j.jfas.2006.12.002

    Article  PubMed  Google Scholar 

  15. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15(7):349–353. https://doi.org/10.1177/107110079401500701

    Article  CAS  PubMed  Google Scholar 

  16. Moracia-Ochagavía I, Rodríguez-Merchán EC (2019) Lisfranc fracture-dislocations: current management. EFORT Open Rev 4(7):430–444. https://doi.org/10.1302/2058-5241.4.180076

    Article  PubMed  PubMed Central  Google Scholar 

  17. Raikin SM, Elias I, Dheer S, Besser MP, Morrison WB, Zoga AC (2009) Prediction of midfoot instability in the subtle Lisfranc injury. Comparison of magnetic resonance imaging with intraoperative findings. J Bone Jt Surg Am 91(4):892–899. https://doi.org/10.2106/JBJS.H.01075

    Article  Google Scholar 

  18. Sripanich Y, Steadman J, Krähenbühl N, Rungprai C, Saltzman CL, Lenz AL, Barg A (2021) Anatomy and biomechanics of the Lisfranc ligamentous complex: a systematic literature review. J Biomech 119:110287. https://doi.org/10.1016/j.jbiomech.2021.110287

    Article  PubMed  Google Scholar 

  19. Sripanich Y, Weinberg MW, Krähenbühl N, Rungprai C, Mills MK, Saltzman CL, Barg A (2020) Imaging in Lisfranc injury: a systematic review. Skeletal Radiol 49(1):31–53. https://doi.org/10.1007/s00256-019-03282-1

    Article  PubMed  Google Scholar 

  20. Ponkilainen VT, Partio N, Salonen EE, Riuttanen A, Luoma E, Kask G, Laine H, Mäenpää HM, Päiväniemi O, Mattila VM, Haapasalo HH (2020) Inter- and intraobserver reliability of non-weight bearing foot radiographs compared with CT in Lisfranc injuries. Arch Orthop Trauma Surg 140(10):1423–1429. https://doi.org/10.1007/s00402-020-03391-w

    Article  PubMed  PubMed Central  Google Scholar 

  21. Potter HG, Deland JT, Gusmer PB, Carson E, Warren RF (1998) Magnetic resonance imaging of the lisfranc ligament of the foot. Foot Ankle Int 19(7):438–446. https://doi.org/10.1177/107110079801900704

    Article  CAS  PubMed  Google Scholar 

  22. Sripanich Y, Weinberg MW, Krähenbühl N, Rungprai C, Saltzman CL, Barg A (2021) Reliability of measurements assessing the Lisfranc joint using weightbearing computed tomography imaging. Arch Orthop Trauma Surg 141:775–781. https://doi.org/10.1007/s00402-020-03477-5

    Article  PubMed  Google Scholar 

  23. Kuo RS, Tejwani NC, Digiovanni CW, Holt SK, Benirschke SK, Hansen ST Jr, Sangeorzan BJ (2000) Outcome after open reduction and internal fixation of Lisfranc injuries in athletes. J Bone Jt Surg Am 82(11):1609–1618. https://doi.org/10.2106/00004623-200011000-00015

    Article  CAS  Google Scholar 

  24. Rosenbaum A, Dellenbaugh S, Dipreta J, Uhl R (2011) Subtle injuries to the Lisfranc joint. Orthopedics 34(11):882–887. https://doi.org/10.3928/01477447-20110922-23

    Article  PubMed  Google Scholar 

  25. Lau S, Guest C, Hall M, Tacey M, Joseph S, Oppy A (2017) Functional outcomes post Lisfranc injury –transarticular screws, dorsal bridge plating or combination treatment? J Orthop Trauma 31(8):447–452. https://doi.org/10.1097/BOT.0000000000000848

    Article  PubMed  Google Scholar 

  26. Ebraheim NA, Yang H, Lu J, Biyani A (1996) Computer evaluation of second tarsometatarsal joint dislocation. Foot Ankle Int 17(11):685–689. https://doi.org/10.1177/107110079601701107

    Article  CAS  PubMed  Google Scholar 

  27. van Rijn J, Dorleijn DMJ, Boetes B, Wiersma-Tuinstra S, Moonen S (2012) Missing the Lisfranc fracture: a case report and review of the literature. J Foot Ankle Surg 51(2):270–274. https://doi.org/10.1053/j.jfas.2011.10.048

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

In remembrance of Woon Hyuk Lee (1982–2020), Jun Young Choi is grateful for his help with analyzing data and English editing.

Funding

Authors have no other contributors and sources of funding.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea

    Jun Young Choi, Oh Jun Yu & Jin Soo Suh

Authors
  1. Jun Young Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oh Jun Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jin Soo Suh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin Soo Suh.

Ethics declarations

Conflict of interest

Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Choi, J.Y., Yu, O.J. & Suh, J.S. Factors influencing postoperative residual diastasis after the operative treatment of acute Lisfranc fracture dislocation. Arch Orthop Trauma Surg 142, 2685–2694 (2022). https://doi.org/10.1007/s00402-021-04058-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-021-04058-w

Keywords

Search

Navigation