High-Energy Midfoot Fracture–Dislocations: Staged Treatment With an External Fixator


The purpose of this study was to analyze the clinical outcomes of patients treated for high-energy midfoot (Lisfranc) injuries with initial temporization of an external fixator before definitive fixation. A retrospective chart review at two level 1 trauma centers was completed. Clinical parameters including demographics and comorbidities were evaluated in addition to hospital and clinical data. Time to full weight bearing took an average of 4.4 months, and with the numbers available no significant difference (p > .05) was found between the open reduction and internal fixation (ORIF) group and the arthrodesis group in regard to length of stay, days from initial reduction with an external fixator to definitive fixation, time to full weight bearing, or return to work. Staged treatment of high-energy Lisfranc injuries with external fixation demonstrated minimal soft tissue complications similar to other series reported in the literature. Definitive stabilization with either ORIF or arthrodesis produced similar results in staged treatment of these injuries. (Journal of Surgical Orthopaedic Advances 28(1):24–30, 2019)
Key words: external fixation, Lisfranc fracture, midfoot fracture, tarsometatarsal fracture–dislocation

John E. Arvesen, MD; Zachary Burnett, MD; Heidi Israel, PhD; J. Tracy Watson, MD; and Lisa K. Cannada, MD