Open reduction internal fixation, Lisfranc

Type of Procedure: Outpatient

Length of Procedure: 1-1.5 hour

Anesthesia: Regional nerve block with general anesthesia or sedation

Medications: Oxycodone or Norco for pain, aspirin 81 mg twice daily for 3 weeks to lower risk of blood clots, ondansetron for nausea

Follow-up appointments: 2 weeks, 6 weeks, 12 weeks

Time Non Weight Bearing: 6 weeks no weight, 4-6 weeks weight bearing in boot

Time to Driving: When off narcotics for left foot unless you have a clutch, 11-13 weeks for right foot

Lisfranc Injuries: General facts

• The Lisfranc (tarsometatarsal) joint is the joint that connects your midfoot to your forefoot
• The Lisfranc ligament is a strong ligament that connects your medial cuneiform bone to the base of the second metatarsal
  • It is important in supporting the arch of your foot
• Injury to the Lisfranc ligament is usually caused by high energy accidents (falls from height or car accidents) or athletic injuries where the foot is pointing down and someone/something lands on the foot or heel
• Can involve one or many joints and is sometimes associated with fractures in the base of the metatarsals
• Diagnosis can often be made on weight bearing x-rays but sometimes more advanced imaging including MRI and CT scan are required to confirm the diagnosis
• If left untreated, there are high rates of collapse of the arch and development of severe arthritis of the midfoot

Treatment of Lisfranc Injuries

• If there is just a sprain to the Lisfranc ligament, a period of non weight bearing for 6 weeks in a boot is used
• If there is complete injury to the Lisfranc ligament or disruption of the Lisfranc joint, surgery is generally recommended
• Surgery typically involves an incision over the top of the foot
• The joint/s are aligned in the appropriate alignment and held with plates and/or screws
• The goal is to align the joints and allow your body to heal the ligament
• Usually, the plates and/or screws are removed in a second procedure 4-4.5 months after the initial surgery

Before Surgery:

1. Elevate extremity
2. Ice the affected ankle
3. Do not put weight on the foot while in your boot

After Surgery:

1. Immediately after:
   1. In splint below the knee (do not get splint wet)
   2. Elevate the leg, ice, take pain medication
   3. No weight (use crutches, walker, knee scooter, or wheelchair)
2. 2 week appointment:
   1. Stitches come out and steri-strips placed
   2. Placed into boot
   3. Begin moving the ankle and toes on own at home
   4. May run soapy water down incisions but do not scrub or soak
   5. No weight allowed after this visit
3. 6 week appointment:
   1. May begin placing weight on the foot in the boot
   2. Start physical therapy to work on strength and motion
   3. Can go into a swimming pool and use stationary bike (seated)
4. 12 week appointment:
   1. Transition to a shoe with the help of physical therapist
   2. Continue working on range of motion and strength
   3. Avoid high impact activities including running and jumping
   4. Plan for removal of hardware at 4-4.5 months