Overview
In this multicenter cohort study, the stability of non-displaced Lisfranc injuries as well as their outcomes will be evaluated.
Description
Injuries to the tarsometatarsal joints ("Lisfranc injuries") that are non-displaced on non-weightbearing radiographs and CT are common injuries. To refer these injuries to the right treatment, evaluating their stability is essential. For this purpose, both weightbearing radiographs and stress fluoroscopy have been proposed. However, there is no consensus concerning both the use and interpretation of weightbearing radiographs and no standardized technique and interpretation of stress fluoroscopy in non-displaced Lisfranc injuries.
In the current study, participants will be assigned to non-operative or operative treatment based on Lisfranc joint stability evaluation by weightbearing radiographs.
All Patients with negative weightbearing radiographs will be treated conservatively. In addition, their injured feet will be evaluated by manual stress fluoroscopy. Depending on the result of the stress fluoroscopy (positive/negative), the conservatively treated patients will be assigned to 2 cohorts, whose outcomes will be compared.
Patients with positive weightbearing radiographs will be treated operatively by minimally invasive stabilization of the midfoot (eg. isolated "homerun screw"). The operatively treated patients will be followed up as an independent cohort.
Eligibility
Inclusion Criteria:
- Acute Lisfranc injuries that are non-displaced (< 2mm) on non-weightbearing radiographs and CT
- Patients between 18 and 70 years of age
- Acute presentation at one of our departments, enabling evaluating the stability of the injuries within 4 weeks
Exclusion Criteria:
- Fractures with an intraarticular step of > 2mm on the initial non weight-bearing radiographs and/or CT
- Delayed presentation (weight-bearing radiographs taken > 4 weeks after injury)
- Bilateral injuries
- Concomitant major injuries of the foot, ankle or leg that affect the rehabilitation process
- Multitraumized patients
- Previous injury or surgery of the mid foot
- Charcot foot
- Noncompliant patients
- Insufficient Norwegian or English language skills
- Patients not available for follow-up
- Inability to conduct the rehabilitation protocol