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


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