Foot & Ankle International - July 2018 - 804

804

Foot & Ankle International 39(7)

Figure 2. Amount of sports played and limiting factors after surgery.

pain. Of these 6 patients, 2 patients had to cease all sporting
activity, 2 were able to return to low-impact sports only, and
2 returned to high-impact sports but at reduced frequency
and intensity.
Overall, there was a general satisfaction rate of 97% (n =
32), with only 1 patient dissatisfied with the operative outcome in terms of return to sports and physical activities.

Foot and Ankle Outcome Scores
The mean FAOS subscores were as follows: Symptoms,
87.3 (range, 21.4-100); Pain, 92.3 (range, 44.4-100);
Activities of Daily Living, 97 (range, 72-100); Sports and
Recreational Activities, 85.9 (range, 50-100); Foot and
Ankle Quality of Life, 73 (range, 31.2-100). Mean total
FAOS score was 87.1 (range, 51.8-100).
There was strong correlation between the patients' overall scores for the FAOS and Sports Questionnaire (rs = 0.80,
P < .001). There was weak correlation between total FOAS
scores and time from surgery, but the result did not reach
significance (rs = 0.27, P = .129).

Complications
There were no cases of deep wound infection or nerve
damage. All patients underwent removal of hardware
with no complications. No patients required conversion to
arthrodesis.

Discussion
This study assessed the ability of recreational athletes with
Lisfranc injuries to return to sports after ORIF with a
Lisfranc screw combined with bridge plating technique. We

found that most patients (94%) were able to return to at least
some level of physical activity or sport, with only 2 patients
severely restricted by their symptoms. Eighty percent of
patients were able to return to at least their preinjury level
of sporting activities. Even though 33% of patients reported
some degree of pain, only 18% of the cohort had to reduce
their level of activity because of their symptoms. This suggests that many patients experience ongoing symptoms that
were likely minor in nature.
Bridge plate fixation has been advocated in recent years
as an alternative to transarticular screw fixation or arthrodesis, but controversy still remains about the best treatment
method for closed Lisfranc injuries.12 A cadaveric study
showed that a 3.5-mm screw can damage up to 4.8% of the
articular cartilage of the TMT joint.1 Bridge plating has the
advantage of avoiding iatrogenic injury to the articular surface of TMT joints, hence theoretically reducing the risk of
developing posttraumatic arthritis, pain, and long-term disability.12 There is a small articulation between the anterodorsal medial cuneiform and posterodorsal second metatarsal.6,13
This dorsal articular surface can be damaged by the Lisfranc
screw if inserted inappropriately. Aiming of the screw
through the midsagittal plane of the C1-M2 joint with the aid
of intraoperative fluoroscopy can avoid the violation of the
dorsal articulation and prevent such iatrogenic injury.
Biomechanically, there was no significant difference
between the dorsal plate and screw fixation in maintaining
the TMT joint alignment during loading.1,24 Clinically, the
results of bridging plating were comparable to transarticular
fixation with regard to wound complications, rate of implant
removal, American Orthopaedic Foot & Ankle Society
score, Foot Function Index score, and patient satisfaction.14
In the authors' institution, ORIF with Lisfranc screw and
bridge plating the affected TMT joints is the routine method
Table of Contents for the Digital Edition of Foot & Ankle International - July 2018
