High Energy Midfoot Fracture-Dislocations: Does Staged Treatment with External Fixation Help?

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This study analyzes the outcomes of patients treated for high energy midfoot injuries with temporary stabilization (TS) prior to definitive operative fixation compared to a control group (C) treated initially with splint only. Three Level 1 trauma centers reduced and temporized high energy Lisfranc injuries. A matched control group was compared with the intervention group. Clinical parameters, complications and need for additional surgery were evaluated. There were 15 patients in group C and 29 patients with temporary stabilization (TS). Both the TS and C groups demonstrated no significant diff erence in the number of additional operations, infection rate, incidence of deep vein thrombosis (DVT), nonunion and need for orthotics postoperatively (p > 0.05). Staged treatment of high energy Lisfranc injuries in the TS group led to a delay in definitive fixation or arthrodesis while having a similar minimal complication rate relative to the controls. This is a Level III, Retrospective Case Control Study. (Journal of Surgical Orthopaedic Advances 29(3):154–158, 2020) Key words: Lisfranc fracture, midfoot fracture, tarsometatarsal fracture-dislocation, external fixation

John Arvesen, MD; Zachary Burnett, MD; Ashleigh N. Bush; Heidi Israel, PhD; Brian Mullis, MD; and Lisa K. Cannada, MD