Acute Lisfranc injuries: Simultaneous 2nd and 3rd tarso-metatarsal joint fusion using Medartis® aptus wing plate: A retrospective cohort study

Abstract text (incl. references and figure legends)

Introduction: Lisfranc injuries can have devastating consequences and are often associated with poor functional outcomes and high rates of disability, due to arch collapse and post-traumatic arthritis. Anatomical reduction of the midfoot arch and fusion of the Lisfranc joint is essential in preventing these outcomes. While dorsal plating has been proved to provide satisfactory biomechanical and clinical outcomes, the simultaneous 2nd and 3rd tarsometatarsal joint fusion using a single locking plate may combine the already proved superior fatigue resistance with improved sort and long-term clinical outcomes.Materials/Methods: 26 patients (18 men, 8 women) with acute Lisfranc injuries were retrospectively analyzed; all underwent open reduction and internal fixation, using a simultaneously 2nd and 3rd tarsometatarsal joint fusion using a single locking plate between 2017-2021. They were followed up for at least 18 months and AOFAS score, X-rays and CT"s were used to assess their postoperative clinical progress.Results: 24 Patients with a median age of 34[27-48] completed the follow up protocol with a mean follow up time of 24 months[18- 42] and analyzed per protocol. The median Injury to Surgery Time was 8 days[4-21]. Their mean AOFAS score at 6 month was calculated to 74%[± 9%] and in the 18th month 81%[± 12%]. OA lesions developed in 1 patient in 26 months. 2 postop infection cases were addressed with antibiotics and hardware removal. Chronic pain was reported in 2 cases. 1 of them underwent revision arthrodesis, due to non-union. Conclusion: Simultaneously 2nd and 3rd tarsometatarsal joint fusion, using a single locking plate, may lead to better functional outcome and a lower incidence of post-traumatic arthritis and fatigue related complications, when compared to standard two plate technique. A larger prospective comparative study is required to produce higher-quality evidence.

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