Arthrodesis of the Lisfranc Joint Complex With a New Multidirectional Locking Plate: Midterm Results

Lisfranc injuries generally have a poor prognosis with considerable potential for long-term disability. Currently, the recommended treatment of Lisfranc injuries is open reduction and internal fixation (ORIF), as closed reduction and plaster immobilization alone often leads to a painful loss of function of the medial arch of the foot. Furthermore, there are studies that propose primary arthrodesis as a treatment option for complex fractures. In addition, the necessity for arthrodesis not only arises from posttraumatic etiology but also from primary degenerative arthritis. For metatarsal cuneiform arthrodesis, screw fixation is the traditional fixation method. However, plate fixation is becoming increasingly common. In December 2007, a novel multidirectional locking plate was introduced in our hospital (wingplate). Through October 2010, a total of 14 patients underwent a metatarsal cuneiform arthrodesis of the medial arch of the affected Lisfranc joints. In some cases, an additional fusion of the middle Lisfranc joint (Tarso metatarsal II and III) with a 3.5-mm lag screw was performed by placing the screw from medial to lateral for a fixation of the base of metatarsal I and II. Clinical and radiologic followup was possible for 11 of the 14 patients. The average follow-up was 16 months (6 to 39 mo). The etiology of the 11 metatarsal cuneiform arthrodesis patients was posttraumatic in 4 cases, whereas it was performed primary in 1 case and secondary in 3 cases, and degenerative in 7 cases. Union was reported in 91% (10 of 11) patients with a mean time to union of 143 days. Mean American Orthopaedic Foot and Ankle Society midfoot score was 85.64, with a reduction in the visual analog scale score from 8.36 preoperatively to 1.82 postoperatively. The patient with the documented nonunion had an American Orthopaedic Foot and Ankle Society midfoot score of 91 and a reduction in the visual analog scale score from 10 preoperatively to 0 postoperatively, showing that nonunion may not correlate with poor function or pain. These promising clinical midterm results show that the APTUS titanium wing-plate, combined with or without additional lag screws, offers a good option for Lisfranc arthrodesis in posttraumatic and degenerative arthritis.