Journal of Foot and Ankle Surgery - 2026-04-20 - Journal Article
Risk Factors for Postoperative Complications in Lisfranc Injuries Treated With Open Reduction and Internal Fixation: A Multicenter Study.
Minoura Y, Takegami Y, Nakashima H, Mishima K, Mabuchi M, Imagama S
Topics
Key Takeaway
After ORIF for Lisfranc injuries, overall complication rate was 70.0%, with open fractures (AOR 2.79) and high-energy mechanisms (AOR 2.13) as independent risk factors, while combined screw-and-plate fixation reduced complication risk by 77% (AOR 0.23).
Summary Depth
Choose how much analysis to show on this article page.
Summary
This multicenter retrospective study of 172 adults undergoing joint-preserving ORIF for Lisfranc injuries at 11 hospitals (2014–2024) sought to identify independent predictors of postoperative complications and reoperation. Complications occurred in 70.0% of patients, most frequently post-traumatic arthritis (29.7%), malunion (22.1%), and sensory impairment (13.4%); reoperation was required in 25.6%. On multivariate regression, open fractures (AOR 2.79) and high-energy injury (AOR 2.13) independently predicted complications, while combined screw-plate (AOR 0.23) and screw-only constructs (AOR 0.43) were protective; no independent predictors of reoperation were identified.
Key Limitation
The absence of a reported mean follow-up duration across the 172 patients prevents meaningful interpretation of the 29.7% post-traumatic arthritis rate, as this outcome is highly time-dependent.
Original Abstract
BACKGROUND
Lisfranc injuries compromise foot stability and may lead to chronic instability and post-traumatic arthritis if inadequately treated. Open reduction and internal fixation (ORIF) is a standard surgical option, but multicenter data on risk factors for postoperative complications remain limited.
PURPOSE
To identify risk factors for postoperative complications and reoperation after ORIF for Lisfranc injuries.
STUDY DESIGN
Multicenter retrospective cohort study.
METHODS
We retrospectively reviewed 172 adult patients who underwent joint-preserving ORIF for Lisfranc injuries at 11 hospitals between 2014 and 2024. No cases of primary arthrodesis were included. Patient demographics, injury characteristics, and fixation methods were analyzed. Multivariate logistic regression was performed to identify independent predictors of postoperative complications and reoperation.
RESULTS
Postoperative complications occurred in 119 patients (70.0%), most commonly post-traumatic arthritis (29.7%), malunion (22.1%), and sensory impairment (13.4%). Reoperation was required in 44 patients (25.6%), most commonly for unplanned implant removal (14.0%). Open fractures (adjusted odds ratio [AOR], 2.79; 95% confidence interval [CI], 1.23-6.35; p = 0.015) and high-energy injuries (AOR, 2.13; 95% CI, 1.07-4.26; p = 0.032) were independently associated with postoperative complications. Combined screw and plate fixation (AOR, 0.23; 95% CI, 0.069-0.79; p = 0.019) and screw fixation alone (AOR, 0.43; 95% CI, 0.20-0.94; p = 0.033) were associated with lower complication risk. No independent predictors of reoperation were identified.
CONCLUSION
Open fractures and high-energy injuries were independent risk factors for postoperative complications after ORIF for Lisfranc injuries. More robust fixation constructs, particularly combined screw and plate fixation, may help reduce complication risk.