Outcome after anatomic reduction and transfixation with Kirschner wires of Lisfranc joint injuries

Injuries to the tarsometatarsal (Lisfranc) joint are uncommon, and the results of treatment are often unsatisfactory. Open reduction and internal fixation has been recommended as the treatment of choice for most unstable injuries. In the present study, we reviewed 16 patients who underwent closed or open reduction and Kirschner-wire transfixation of a Lisfranc injury in an 11-year period. Mean follow-up was 44 (range, 12–108) months. Average American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score was 78 (range, 45–100) points. Eight patients (50%) developed posttraumatic arthritis of the tarsometatarsal joints. The major cause was nonanatomical reduction, whereas patients with purely ligamentous injury showed a trend toward poorer postoperative outcome. On the basis of our study, open anatomical reduction of fracture-dislocations of the Lisfranc joint and Kirschner-wire transfixation leads to the best long-term outcome.