Injury Patterns and Early Postoperative Malreduction Following Surgical Treatment of Unstable Lisfranc Injuries

Lisfranc (tarsometatarsal) joint injuries are uncommon but potentially disabling and may lead to chronic pain and deformity if misdiagnosed or inadequately treated. Despite advances in imaging and surgical techniques, epidemiologic and radiographic data on unstable Lisfranc injuries remain limited. This retrospective descriptive study included consecutive adult patients with surgically treated unstable Lisfranc injuries at a Level I trauma center and a tertiary orthopedic referral hospital between January 2018 and December 2024. Demographic characteristics, injury mechanisms, associated fractures, and fixation methods were recorded. Injuries were classified according to the Hardcastle–Myerson system. Postoperative malreduction was assessed using predefined radiographic criteria, including diastasis or displacement exceeding 2 mm. Statistical analyses were performed using SPSS (version 26), with a significance threshold of p < 0.05. A total of 280 patients were included (mean age 36.6 ± 13.6 years; 77.9% male). High-energy trauma accounted for 75.0% of cases, most commonly motor vehicle accidents (48.2%). Type B2 injuries were the most frequent pattern (68.2%). Associated foot and ankle fractures were identified in 60.4% of patients, most commonly involving the base of the second metatarsal (78.7% of fractures). Early postoperative malreduction was observed in 34.3% of cases, most frequently between the base of the second metatarsal and the intermediate cuneiform. Malreduction occurred more often in cases treated with K-wire fixation than with screw fixation. Unstable Lisfranc injuries predominantly affect young men following high-energy trauma and are most commonly characterized by Type B2 patterns and associated second metatarsal base fractures. Early postoperative malreduction remains frequent. These descriptive findings improve understanding of the epidemiologic and radiographic characteristics of unstable Lisfranc injuries and may assist clinicians in diagnostic and surgical decision-making. Level IV, according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.