Functional outcomes of memory staple fixation for Lis-franc injuries -our experience from a major trauma center.

Abstract

Background: Lisfranc injuries are complex and serious involving fractures-dislocations through the tarsometatarsal joints of the foot. Failure to diagnose or treat these injuries appropriately has been complicated with acute and long-term morbidity. When surgery is indicated, open reduction and internal fixation is mostly recommended but the option of primary fusion has role in some situations. There are different methods of fixation ranging from intra-articular screw fixation to bridge plate fixation. The use of staples provides a low profile extra-articular fixation with less joint surface damage and soft tissue irritation. We report the results of using memory staples fixation of Lisfranc injury from a major trauma center.

Patients and methods: We retrospectively reviewed a consecutive series of nineteen patients who underwent memory staple fixation of Lisfranc injuries at a Level 1 major trauma centre. All surgeries were performed by the senior author SAA. Patients were followed up at regular intervals after operation, with clinical and radiographic assessment of progress of healing and any complications. Clinical and functional outcomes were assessed at their final follow-up. Functional outcomes were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scores.

Results: At the end of the follow-up, the mean AOFAS midfoot score was 71.89 (S.D-17.5, 95% CI-63.5-80.3). Excellent outcome (score ≥90) was obtained in two patients, good (90> score ≥75) in seven patients, fair (75> score ≥50) in eight patients and poor (score≤49) in two patients. Gender or associated injuries did not show any statistical difference in AOFAS midfoot scores but there was some relation with poorer outcomes in patients who had broken staples (p=0.003).

Conclusions: The use of staple fixation in Lisfranc injury involves simple technique with satisfactory fixation and good functional outcomes. There are tangible advantages due to extra-articular fixation with no iatrogenic damage to the articular surfaces and the low profile of these implants reduces the risk of soft tissue irritation and symptomatic metal ware.