What is the treatment for a Lisfranc fracture?

From the Guidelines

The treatment for a Lisfranc fracture typically involves surgical intervention to restore proper alignment and stability of the midfoot, as most Lisfranc injuries require this approach to prevent chronic pain, post-traumatic arthritis, and significant functional limitations. For non-displaced fractures (where bones remain properly aligned), non-surgical treatment may be appropriate, including immobilization in a cast or boot for 6-8 weeks with strict non-weight bearing for the first 6 weeks, as noted in 1. However, the decision to operate is often based on the severity of the injury and the presence of displacement or instability.

Surgery typically involves open reduction and internal fixation (ORIF) using screws and plates to realign and stabilize the bones. In some cases, primary fusion (arthrodesis) may be recommended, particularly for severely comminuted fractures or when there is significant cartilage damage. The importance of accurate diagnosis, potentially aided by weightbearing radiographs as suggested in 1, cannot be overstated, as it directly influences the choice of treatment. Following surgery, patients must maintain non-weight bearing status for 6-8 weeks, followed by progressive weight bearing in a walking boot for another 4-6 weeks.

Key aspects of recovery include:

• Physical therapy to restore strength, range of motion, and function
• Pain management, which may include NSAIDs like ibuprofen or naproxen, and sometimes short-term opioids immediately post-surgery
• Close monitoring for potential complications, such as infection, nerve damage, or hardware failure. Given the potential for long-term morbidity associated with Lisfranc injuries, prioritizing aggressive and appropriate treatment is essential, as supported by the principles outlined in 1 and the diagnostic approaches discussed in 1.

From the Research

Treatment Options for Lisfranc Fracture

The treatment for a Lisfranc fracture can vary depending on the severity and type of injury. Some of the treatment options include:

• Conservative treatment, which is only indicated in stable lesions and those without displacement, along with immobilisation and initial avoidance of weight-bearing 2
• Surgical treatment, which aims to achieve optimal anatomical reduction and stability of the first, second, and third cuneiform-metatarsal joints 2
• Open reduction and internal fixation (ORIF) with transarticular screws or dorsal plates, which is a preferred surgical treatment for Lisfranc injuries involving fracture 2, 3
• Primary arthrodesis, which is a common approach for primarily dislocation injuries 3
• Combined medial column arthrodesis with ORIF of the central column, which is a hybrid approach that has shown promising results in treating Lisfranc injuries 3
• Extra-articular fixation using dorsal plates, which avoids damage to the articular surface and can help reduce the risk of chronic pain and disability 4

Surgical Approaches

There are different surgical approaches that can be used to treat Lisfranc fractures, including:

• Open reduction and internal fixation (ORIF) with a plantar plate approach, which has been shown to provide relief, stability, and compression of the joint in patients with traumatic injuries to the Lisfranc joint 5
• Dorsal plate approach, which is a common approach used in ORIF procedures for Lisfranc injuries 2, 4
• Medial column arthrodesis with ORIF of the central column, which is a hybrid approach that involves fusing the medial column and stabilizing the central column with internal fixation 3

Importance of Anatomical Reduction

Anatomical reduction is crucial in the treatment of Lisfranc fractures, as it can help prevent long-term complications such as post-traumatic osteoarthritis and foot deformities 2, 6. The correct alignment of the foot axes, including a correct length proportion of the medial and lateral foot columns, is also important for achieving good gait function after a Lisfranc injury 6.