title: Military personnel sustaining Lisfranc injuries have high rates of disability separation.
abstract: OBJECTIVE
  Lisfranc injuries are relatively uncommon midfoot injuries disproportionately affecting young, active males. Previous studies in civilian populations have reported relatively good results with operative treatment. However, treatment results have not been specifically examined in military personnel, who may have higher physical demands than the general population. The purpose of this study was to examine rates of return to military duty following surgical treatment of isolated Lisfranc injuries.
  
  
  METHODS
  Surgical records and radiographic images from all active duty US military personnel treated for an isolated Lisfranc injury between January 2005 and July 2014 were examined. Demographic information, injury data, surgical details and subsequent return to duty information were recorded. The primary outcome was ability to return to unrestricted military duty following treatment. The secondary outcome was secondary conversion to a midfoot arthrodesis following initial open reduction internal fixation.
  
  
  RESULTS
  Twenty-one patients meeting inclusion criteria were identified. Median patient age was 23 years, and mean follow-up was 43 months. Within this cohort, 14 patients were able to return to military service, while seven required a disability separation from the armed forces. Of the 18 patients who underwent initial fixation, eight were subsequently revised to midfoot arthrodesis for persistent pain.
  
  
  CONCLUSIONS
  Military personnel sustaining Lisfranc injuries have high rates of persistent pain and disability, even after optimal initial surgical treatment. Military surgeons should counsel patients on the career-threatening nature of this condition and high rates of secondary procedures.
authors.affiliation: Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
authors.forename: George C
authors.identifier: http://orcid.org/0000-0003-2822-2986
authors.initials: GC
authors.lastname: Balazs
authors.affiliation: Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Hanley
authors.affiliation: Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
authors.forename: G J
authors.initials: GJ
authors.lastname: Pavey
authors.affiliation: Department of Orthopaedics and Rehabilitation, United States Naval Academy, Naval Health Clinic Annapolis, Annapolis, Maryland, USA.
authors.forename: J-Ph
authors.initials: JP
authors.lastname: Rue
mesh_terms: D000328:Adult; D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries / Q000601:surgery*; D008889:Military Personnel; D012189:Retrospective Studies; D062707:Return to Work; D013639:Tarsal Bones / Q000293:injuries / Q000601:surgery*; D055815:Young Adult
keywords: Lisfranc Injuries; Military Personnel; Return to Duty