Functional and clinical outcomes following Lisfranc injuries in Togo: An 8 to 14-year follow-up study

Abstract

Background: Lisfranc dislocations and fracture-dislocations can cause lasting disability. Data from low-resource settings remain limited. Objective: To describe epidemiology, injury patterns, management and long-term outcomes. Methods: Single-centre retrospective-prospective series of 27 consecutive patients treated between 1 June 2011 and 31 May 2017. Injuries were classified according to Myerson. Outcomes were assessed using the AOFAS midfoot score and a four-level satisfaction scale. Results: Young male adults injured in road traffic crashes predominated. Myerson distribution was A N=12 (44.4%), B1 N=6 (22.2%), B2 N=6 (22.2%), and C2 N=3 (11.1%). Open injuries were present in 24/27 (88.9%) and fracture-dislocations in 22/27 (81.5%). Initial treatment consisted of open reduction and internal fixation with K-wire pinning (N=13), orthopaedic treatment (N=10), primary amputation (N=3), and primary arthrodesis (N=1). Among 17 patients with functional evaluation at the long-term horizon, the American Orthopaedic Foot and Ankle Society Score averaged 69.64 (range, 48-100), with patient satisfaction rated as 3 excellent, 5 good, 7 fair, and 2 poor. Five patients initially treated orthopaedically later underwent secondary screw arthrodesis for painful post-traumatic degeneration or instability. Conclusion: In our context with many open injuries, K-wire pinning predominated and screw constructs were not used initially. Long-term function was moderate, and delayed screw arthrodesis was required in a subset of cases initially managed non-operatively.