title: Screw and wire fixation for Lisfranc fracture dislocations.
abstract: OBJECTIVE
  To assess mid-term outcome of screw and wire fixation for Lisfranc fracture dislocations to determine the risk factors of post-traumatic arthritis.
  
  
  METHODS
  15 men and 4 women aged 21 to 58 (mean, 41) years with Lisfranc fractures underwent open/ closed reduction and internal fixation (using screw and wire). Fractures were classified as homolateral (n=7), isolated (n=7), and divergent (n=5). Six patients had open fractures; 8 patients injured 5 tarsometatarsal joints; and 6 patients had pure ligamentous injury. Outcome (pain, function, and cosmesis) was assessed using the Maryland foot score and the American Orthopedic Foot and Ankle Society (AOFAS) score. Weight-bearing radiographs were evaluated for non-union, subluxation, malalignment, and post-traumatic arthritis.
  
  
  RESULTS
  Patients were followed up for 24 to 40 (mean, 30) months. Patients with anatomic reduction (n=14) achieved higher mean AOFAS foot score (79.3 vs. 67.5, p=0.0007) and Maryland foot score (80.4 vs. 69.4, p=0.0009) than did patients with non-anatomic reduction (n=5). Post-traumatic arthritis occurred significantly more often in patients with non-anatomic than anatomic reduction (3/5 vs. 1/14, p=0.037). Four patients developed post-traumatic arthritis, one of whom also developed lateral subluxation after implant removal. Two patients developed flat foot. Two patients had severe symptoms that limited function, one of whom underwent an arthrodesis. Two patients with compound fractures developed superficial infections. Three patients had broken screws.
  
  
  CONCLUSIONS
  Anatomic reduction is the main predictor of outcome in patients with Lisfranc fracture dislocations.
authors.affiliation: Department of Orthopaedics, RN Cooper Municipal General Hospital, Juhu, Mumbai, India. ssushantghate@gmail.com
authors.forename: Sushant D
authors.initials: SD
authors.lastname: Ghate
authors.forename: Vidyasagar M
authors.initials: VM
authors.lastname: Sistla
authors.forename: Vijay
authors.initials: V
authors.lastname: Nemade
authors.forename: Dinesh
authors.initials: D
authors.lastname: Vibhute
authors.forename: Sunil M
authors.initials: SM
authors.lastname: Shahane
authors.forename: Ashwin D
authors.initials: AD
authors.lastname: Samant
mesh_terms: D000328:Adult; D001863:Bone Screws; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries*; D008875:Middle Aged; D013640:Tarsal Joints / Q000293:injuries*; D055815:Young Adult