Thirty-one patients met inclusion criteria for this study with ages ranging from eighteen to 73 years old (mean age 39.8 ± 15.9 years). Five patients were further excluded from analysis: two patients were lost to follow up before initial postoperative evaluation, two patients underwent ipsilateral below-knee amputations within 3 days of injury, and one patient was excluded due to lack of radiographs. Twenty six patients remained eligible for analysis. Mean age for these patients was 41.0 ± 16.9 years. Six (23.1%) patients were female and fifteen (57.7%) patients had right foot injuries; no patients had bilateral Lisfranc injuries. Seven (26.9%) patients had staged hardware removal with a mean 15.7 weeks to partial hardware removal and seventeen (65.4%) patients underwent one-stage hardware removal with a mean 14.5 weeks to hardware removal. Two (7.7%) patients retained their hardware in both medial and lateral columns. Mean follow-up was 88.2 ± 114 weeks for all patients.
Twelve (46.2%) patients had lateral column disruption treated with K-wire fixation and thirteen (50.0%) were treated with screw fixation; one (3.8%) patient was treated with a combination K-wire and screw construct and was grouped in the K-wire cohort for analysis. There were no differences in age, sex, laterality, or open/closed injury status between groups (Table 1). Patients that underwent K-wire fixation were significantly more likely to have had concomitant injuries of the ipsilateral foot or ankle (including metatarsal, cuboid, navicular, talus, or distal tibia fractures) than those that underwent screw fixation (6 (50.0%) K-wire vs. 1 (7.1%) screw, p = 0.014).
Most patients healed their fractures in both groups (13 (92.9%) screw vs. 12 (100%) K-wire, p = 0.345). There were no differences between groups with respect to radiographically stable fixation prior to hardware removal, need for hardware removal, staged hardware removal, development of post-traumatic arthritis, and days between surgery and weight-bearing as tolerated (p > 0.05) (Tables 2 and 3). Patients who underwent lateral column fixation with K-wires underwent removal of hardware in significantly fewer days postoperatively than those who underwent screw fixation (78.6 ± 29.7 days K-wire vs. 128.2 ± 37.2 days screw, p = 0.002). Additionally, those with K-wire fixation of the lateral column were more likely to suffer from disuse osteopenia (9 (75.0%) vs. 5 (35.7%), p = 0.045).
Functional outcomes assessed at latest follow-up by the senior orthopaedic traumatologists, including return to unaided mobility and return to normal shoe wear, did not differ significantly between groups (both p > 0.05). One patient in the cortical screw cohort required a one-inch heel lift post-operatively and two patients in the K-wire cohort required a cane for ambulatory assistance due to a peroneal palsy and ipsilateral cuboid and talus fractures, respectively. Despite requiring an ambulatory aid and specialist shoe wear, one patient reported no pain. Patients that underwent lateral column K-wire fixation were more likely to complain of post-operative pain than those that underwent screw fixation (4 (33.3%) vs 0 (0.0%), p = 0.019), perhaps related to the increased rates of ipsilateral injury noted in that group.