THE OUTCOMES OF CONSERVATIVE AND SURGICAL MANAGEMENT OF LISFRANC INJURIES ARE COMPARABLE: A RETROSPECTIVE COHORT STUDY

Abstract

There is debate over the management of subtle Lisfranc injuries. This study reports the outcomes of a conservative approach in a Major Trauma Centre (MTC). The primary outcome of this study is incidence of complication and further surgery. Secondary outcomes will be Patient Reported Outcome Measure (PROMs) and duration of follow-up. All patients diagnosed with Lisfranc injury at Orthopaedic Trauma clinic over a 5-year period (2020–2024) at a single MTC were identified. Patient records were examined to identify complications (neurovascular, infection), further surgeries (removal of metalwork, joint fusion, other) and time to discharge. PROMs data collection using Manchester Oxford Foot Questionnaire (MOXFQ) is pending ethical approval. 509 records were screened identifying 118 Lisfranc diagnoses. 61 patients were managed conservatively and 57 were managed surgically. 8 patients presented late, all of whom were treated surgically. There was no statistically significant demographic difference between the conservative and surgical treatment groups (conservative median age 41y, IQR 28y, 54.1% female; surgical median age 42y, IQR 29.5y, 54.4% female; p-value[age] 0.31, p-value[sex] 0.80). Energy of injury had no significant bearing on treatment modality (conservative 34.4% high energy, surgical 40.4% high energy; p-value 0.76). Median time to discharge was significantly shorter in the conservatively managed group (conservative 111.5 days, surgical 348.5 days; p-value<0.05). The incidence of complication was higher in the surgical group (relative risk 7.5, p-value <0.05). There was no significant difference in incidence of further surgery. This study will be the largest retrospective cohort study to report comparative outcomes of conservative and surgical management of Lisfranc injury. Data available so far conclusively demonstrate non-inferiority of conservative management. The authors note significant heterogeneity of diagnostic methods for Lisfranc injury both within this MTC and in published literature. A follow-up study to define Lisfranc injury and its diagnosis is planned. Acknowledgement: Keri Swain, Edinburgh Orthopaedics.