Long-term results of staged management of complex lisfranc and chopart injury: a retrospective cohort study and systematic literature review.

PURPOSE

The aim was to assess the long-term functional outcome and quality of life after staged surgical treatment of complex Lisfranc and Chopart injuries in a patient cohort, and to perform a systematic review of the literature.

METHODS

A retrospective cohort of all trauma patients with complex Lisfranc and/or Chopart injuries treated at our level 1 trauma center between July 1, 2010, and July 1, 2020 with ≥ 3 years follow-up was analyzed in terms of management, complications, and patient-reported outcomes (American Orthopaedic Foot & Ankle Society midfoot score, AOFAS and Foot Function Index, FFI). A systematic review of the literature (according to PRISMA 2020 guidelines) was performed of studies published between January 2000 to April 2024. Inclusion criteria were acute, complex Lisfranc and/or Chopart injury, staged treatment, age ≥ 17 years, patient-reported outcome measures and ≥ 1 year follow-up.

RESULTS

Fifteen patients with a median follow-up of 6.6 years (interquartile range 4) were included. First stage treatment involved temporary K-wire fixation (n = 11), debridement (open fractures, n = 4), external fixation (n = 4) and decompression fasciotomy (n = 3). Second stage included primary arthrodesis (n = 4), open reduction and internal fixation (n = 7) or external fixation (n = 1). The median number of surgeries was 3 (2-13). Infection was seen in 5/15 patients; 7/11 patients underwent secondary arthrodesis and one patient underwent amputation due to chronic pain. Overall AOFAS was fair (54.5) and five patients had poor outcome (AOFAS < 49). Three full-length articles were included in the systematic review, reporting fair to good outcome. Risk of bias was serious and certainty of evidence very low.

CONCLUSION

Surgical management of complex Lisfranc and Chopart injuries is challenging, functional outcome was poor to fair, postoperative complication rates are high, and secondary salvage arthrodesis was required in two thirds of ORIF patients.

LEVEL OF EVIDENCE

IV.