Concomitant Lisfranc and ankle injuries: Treatment and outcomes

This is the authors' abstract. We don't add key points for this paper.

Background Lisfranc injuries are a heterogeneous group of injuries with significant incidence of missed diagnoses. Due to the mechanisms of these injuries, other injuries, such as ankle fractures, may occur concomitantly. However, there is a scarcity of literature characterizing the clinical outcomes of these combined injuries. Consequently, there is little consensus on treatment best practices and prognosis. Therefore, this study seeks to describe the injury patterns, treatment approaches and outcomes of these combined injuries. Methods A retrospective study was conducted on nine adult patients with concomitant Lisfranc and ankle injuries treated by board certified Foot and Ankle Surgeons at an academic setting from 2022-2025. Patient demographics, injury characteristics, treatment, complications, and clinical and patient reported outcomes were analyzed. Descriptive analyses were conducted. Results Most injuries (n=8, 88%) were caused by low energy. The most common ankle fracture pattern was isolated lateral malleolar fractures (n=4). Of the Lisfranc injuries 6 were bony, while the remaining 3 were ligamentous. Only 3 out of 9 Lisfranc injuries were diagnosed after initial X-ray and exam. Most injuries were treated operatively (6 out of 9 Lisfranc injuries; 8 out of 9 ankle injuries) with open reduction and internal fixation (ORIF); 5 patients received operative treatment for both ankle and Lisfranc injuries. Complications included hardware failure or symptoms, nonunion, and Complex Regional Pain Syndrome (CRPS). PROMIS Pain Interference and Physical Function improved at 3 months post-operatively in the seven patients with post-operative data. Conclusion Unexpectedly, most instances of dual ankle and Lisfranc fractures were precipitated by low energy mechanisms. ORIF was the primary treatment modality with subsequent removal of hardware (ROH) conducted in four out of the nine patients. Most patients had reduced pain levels following surgery. Further study is needed to characterize these injuries and their outcomes relative to isolated ankle and midfoot injuries.