Lisfranc injury fixation is an operation to stabilise a disruption of the tarsometatarsal (Lisfranc) joint complex — the junction between the midfoot and forefoot. These injuries range from subtle ligament sprains to complete fracture-dislocations.
An incision is made on the top of the foot. The displaced joints and fractures are anatomically reduced and fixed with screws or plates. Bridge plating may be used across the joints. In chronic or severely damaged cases, primary fusion of the involved joints may be preferred. The operation takes one and a half to two hours.
Surgery is required for unstable Lisfranc injuries — any displacement of the tarsometatarsal joints needs fixation. Missed or poorly treated Lisfranc injuries lead to chronic midfoot pain and deformity.
Truly stable, undisplaced Lisfranc injuries can be managed in a cast or boot with non-weight-bearing for six weeks. However, most displaced injuries require surgery.
Weight-bearing X-rays and CT scan. The injury is often initially missed — a high index of suspicion is needed.
Anatomic reduction of the Lisfranc joint gives the best chance of a good long-term outcome. However, even with good surgery, some patients develop post-traumatic midfoot arthritis.
Some loss of midfoot flexibility.
Prolonged foot swelling.
Screws usually need removal at three to four months to allow joint mobility.
May develop despite good reduction. May require later fusion.
Rare but serious.
Dorsal cutaneous nerves.
Swollen feet heal slowly.
The joints may not be perfectly reduced.
General or spinal anaesthesia.
Non-weight-bearing for six to eight weeks. Screw removal at three to four months. Gradual return to full weight-bearing. Supportive footwear and orthotics. Full recovery six to twelve months.
X-rays at two weeks, six weeks, and three months. Screw removal planned at three to four months.
Bridge screws across joints restrict normal motion. Removing them after the ligaments have healed allows the joints to regain some flexibility.
Subtle Lisfranc injuries may look nearly normal on initial X-rays. Weight-bearing X-rays and high clinical suspicion are needed. A missed Lisfranc injury leads to chronic pain and deformity.