Objective: The aim of this systematic review was to present the outcome of Lisfranc joint injuries treated with closed reduction and screw percutaneous fixation. Methods: We searched in Pubmed and Google Scholar Databases for articles regarding screw percutaneous fixation of Lisfranc injuries. Seven studies in total were found to be compatible to our search, according to PRISMA guidelines. Four of those met the criteria of the review and they were included in the meta-analysis. A total number of 106 patients were separated into five groups according to the type of injury and the mean AOFAS score of each group was calculated. Cases in which percutaneous fixation was converted to open treatment due to poor reduction were not included in the study. In addition we compared the outcome score between types of injury according to Myerson classification as well as between purely ligamentous and osseoligamentous injuries. The characteristics of all seven selected studies, such as kind of screw used for fixation, post operative protocol, complications and outcome are mentioned as well. Results: Average AOFAS score was 86,2 for type A, 87,54 for type B, and 85 for type C injuries respectively. In pure dislocation group the average AOFAS score was 86,43 and in fracture dislocation group was 87,36. Good to excellent outcome can be expected in patients with different types of injury according to Myerson classification following percutaneous fixation of lisfranc joint injury. Patients with type B injury or a fracture dislocation injury might have better outcome, although this difference was not found to be statistically significant. Conclusion: Percutaneous fixation of tarsometatarsal joint injuries is a relatively simple and safe method of treatment, leading to a good functional outcome, especially for Myerson type B as well as for fracture dislocation type of injuries, provided that an anatomical reduction has been achieved.
___
1. Weatherford BM, Anderson JG, Bohay DR. Management of tarsometatarsal joint injuries. J Am Acad Orthop Surg. 2017 Jul;25(7):469e479. https://doi.org/ 10.5435/JAAOS-D-15-00556.
2. Abdelgaid Sherif Mohamed, Salah Mahmoud, Abdulsalam Samir, Abdulmalak Farid. Closed reduction & percutaneous fixation of lisfranc joints injuries: possibility, technique & results. Clin Res Foot Ankle. 2013 May;1(2). https://doi.org/10.4172/2329-910X.1000109.
3. Bleazey ST\, Brigido SA, Protzman NM. Technique tip: percutaneous fixation of partial incongruous Lisfranc injuries in athletes. Foot Ankle Spec. 2013 Jun;6(3): 217e221. https://doi.org/10.1177/1938640013486515.
4. Meyer SA, Callaghan JJ, Albright JP, Crowley ET, Powell JW. Midfoot sprains in collegiate football players. Am J Sports Med. 1994 May-June;22(3):392e401. https://doi.org/10.1177/036354659402200316.
5. Escudero MI, Symes M, Veljkovic A, Younger ASE. Low-energy lisfranc injuries in an athletic population: a comprehensive review of the literature and the role of minimally invasive techniques in their management. Foot Ankle Clin. 2018 Dec;23(4):679e692. https://doi.org/10.1016/j.fcl.2018.07.014.
6. Puna RA, Tomlinson MP. The role of percutaneous reduction and fixation of lisfranc injuries. Foot Ankle Clin. 2017 Mar;22(1):15e34. https://doi.org/ 10.1016/j.fcl.2016.09.003.
7. Myerson MS, Fisher RT, Burgess AR, Kenzora JE. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle. 1986 Apr;6(5):225e242. https://doi.org/10.1177/107110078600600504.
8. Hardcastle PH, Reschauer R, Kutscha-Lissberg E, Schoffmann W. Injuries to the tarsometatarsal joint: incidence, classification and treatment. J Bone Joint Surg Br. 1982 Jun;64(3):349e356. https://doi.org/10.1302/0301-620X.64B3.7096403.
9. Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains: lisfranc injuries in the athlete. Am J Sports Med. 2002 Nov-Dec;30(6): 871e878. https://doi.org/10.1177/03635465020300061901.
10. Stavlas P, Roberts CS, Xypnitos FN, Giannoudis PV. The role of reduction and internal fixation of Lisfranc fracture-dislocations: a systematic review of the literature. Int Orthop. 2010 Dec;34(8):1083e1091. https://doi.org/10.1007/ s00264-010-1101-x.
11. Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study. J Bone Joint Surg Am. 2006 Mar;88(3):514e520. https://doi.org/10.2106/JBJS.E.00228.
12. Henning JA, Jones CB, Sietsema DL, Bohay DR, Anderson JG. Open reduction internal fixation versus primary arthrodesis for lisfranc injuries: a prospective randomized study. Foot Ankle Int. 2009 Oct;30(10):913e922. https://doi.org/ 10.3113/FAI.2009.0913.
13. Perugia D, Basile A, Battaglia A, Stopponi M, De Simeonibus AU. Fracture dislocations of Lisfranc's joint treated with closed reduction and percutaneous fixation. Int Orthop. 2003 Feb;27(1):30e35. https://doi.org/10.1007/s00264- 002-0396-7.
14. Wagner E, Ortiz C, Villalon IE, Keller A, Wagner P. Early weight-bearing after percutaneous reduction and screw fixation for low-energy lisfranc injury. Foot Ankle Int. 2013 Jul;34(7):978e983. https://doi.org/10.1177/1071100713477403.
15. Lien SB, Shen HC, Lin LC. Combined innovative portal arthroscopy and fluoroscopy-assisted reduction and fixation in subtle injury of the lisfranc joint complex: analysis of 10 cases. J Foot Ankle Surg. 2017 Jan e Feb;56(1):142e147. https://doi.org/10.1053/j.jfas.2016.05.003.
16. Vosbikian M, O'Neil JT, Piper C, Huang R, Raikin SM. Outcomes after percutaneous reduction and fixation of low-energy lisfranc injuries. Foot Ankle Int. 2017 Jul;38(7):710e715. https://doi.org/10.1177/1071100717706154.
17. Robertson GAJ, Ang KK, Maffulli N, Keenan G, Wood AM. Return to sport following Lisfranc injuries: a systematic review and meta-analysis. Foot Ankle Surg. 2018 Aug;(18):30142e30145. https://doi.org/10.1016/j.fas.2018.07.008.
18. Shariff S, Clark C, Dega R. Lisfranc injury classifications. Internet J Orthop Surg. 2008;11(1).
19. Hu SJ, Chang SM, Li XH, Yu GR. Outcome comparison of Lisfranc injuries treated through dorsal plate fixation versus screw fixation. Acta Ortop Bras. 2014 Nov;22(6):315e320. https://doi.org/10.1590/1413-78522014220600576.
20. Kirzner N, Zotov P, Goldbloom D, Curry H, Bedi H. Dorsal bridge plating or transarticular screws for Lisfranc fracture dislocations. Bone Joint J. 2018 Apr;100-B(4):468e474. https://doi.org/10.1302/0301-620X.100B4.BJJ-2017- 0899.R2.
21. Lau S, Guest C, Hall M, Tacey M, Joseph S, Oppy A. Functional outcomes post lisfranc injury-transarticular screws, dorsal bridge plating or combination treatment? J Orthop Trauma. 2017 Aug;31(8):447e452. https://doi.org/ 10.1097/BOT.0000000000000848.
22. Smith N, Stone C, Furey A. Does open reduction and internal fixation versus primary arthrodesis Improve patient outcomes for lisfranc trauma? A systematic review and meta-analysis. Clin Orthop Relat Res. 2016 Jun;474(6): 1445e1452. https://doi.org/10.1007/s11999-015-4366-y.