Original Research Plates, Screws, or Combination? Radiologic Outcomes After Lisfranc Fracture Dislocation Simon Lau, MBBS, BmedSci 1 , Nicholas Howells, MBBS, BSc, MSc, FRCS (TandO), MD 2 , Michael Millar, MD 3 , Daniel De Villiers, MBBS 1 , Samuel Joseph, MBBS, FRACS (Ortho) 4 , Andrew Oppy, MBBS, FRACS (Ortho) 5 1 Orthopaedic Resident, Royal Melbourne Hospital, Parkville, VIC, Australia 2 Orthopaedic Fellow, Royal Melbourne Hospital, Parkville, VIC, Australia 3 Orthopaedic Registrar, Royal Melbourne Hospital, Parkville, VIC, Australia 4 Orthopaedic Consultant, Frankston Hospital, Frankston, VIC, Australia 5 Orthopaedic Consultant, Royal Melbourne Hospital, Parkville, VIC, Australia article info Level of Clinical Evidence: 3 Keywords: Lisfranc outcome plate radiologic screw abstract Traditionally, Lisfranc fracture dislocations have been treated with transarticular screw fixation. A more recent development has been the use of dorsal bridging plates. The aim of the present study was to compare the radiologic outcomes for these 2 methods. Currently, no data comparing the outcomes of these 2 treatment options have been reported. A total of 62 patients were treated for Lisfranc fracture dislocations during a 6-year period. The inclusion criteria included 6 months of follow-up data available. Each fracture was classified using the Hardcastle classification system. Each fracture was also allocated into 1 of 4 groups: transarticular screw fixation, dorsal plating, a combination of plate and screw fixation, and nonoperative management. The outcome measures included the Kellgren-Lawrence grading of osteoarthritis and the Wilppula classification of anatomic reduction. In terms of results, radiologic osteoarthritis is not associated with the type of injury according to the Hardcastle classification nor with having an open or closed fracture. The Hardcastle classification is not associated with the type of fixation used. Fractures fixed with a combi- nation of plates and screws had a 3.01 (95% confidence interval 1.036 to 8.74) increased risk of having stage 3 or 4 radiologic osteoarthritis compared with being fixed solely with bridging plates (p ¼ .009). Multivariate analysis revealed that this increased risk of osteoarthritis was dependent on the quality of reduction, with good reductions having a 18.2 (95% confidence interval 15.9 to 21.8) times decreased risk of severe osteoar- thritis compared with fair or poor reductions, independent of the type of fixation used (p < .0001). No radiologic benefits were found when comparing plate or screw fixation for Lisfranc fracture dislocations (although screw fixation might be associated with a less planus foot and fewer complications). Instead, a good anatomic reduction was the only predictor of the radiologic outcome, and the Hardcastle classification of fractures did not predict the surgery type or radiologic outcome. Finally, treatment with combination plates and screws resulted in worse radiologic outcomes, possibly owing to more complex fracture patterns. Ó 2016 by the American College of Foot and Ankle Surgeons. All rights reserved. Lisfranc fracturesdor fracture/dislocations of the tarsometatarsal joint (TMTJ)dcan leave patients with significant functional deficits. Mechanisms causing Lisfranc injuries range from low-energy twisting injuries to high-velocity trauma (1). The diagnosis of a Lisfranc fracture is usually by the radiologic findings, generally radiographs or computed tomography scans with tarsometatarsal joint displacement of 2 mm, typically necessitating surgery (2). Furthermore, good evidence is available to suggest that a significant factor in achieving superior radiologic and functional outcomes after surgery is the quality of the anatomic reduction (<2 mm) (3). If operative management is pursued, the aims of fixation include maintenance of appropriate medial and lateral column length, maintenance of an appropriately plantar flexed foot and stable internal fixation to retain anatomic reduction (4). Shortening of the medial column tends to produce a cavus foot, and shortening of the lateral column can result in a planus foot (3). For many years, transarticular screw fixation was the recom- mended method of fixation for Lisfranc fracture dislocations (5,6). More recently, a trend has been seen for open reduction and internal Financial Disclosure: None reported. Conflict of Interest: None reported. Address correspondence to: Simon Lau, MBBS, BmedSci, Orthopaedic Office, Level 7E, Royal Melbourne Hospital, Parkville, VIC 3050, Australia. E-mail address: drsimonchlau@gmail.com (S. Lau). 1067-2516/$ - see front matter Ó 2016 by the American College of Foot and Ankle Surgeons. All rights reserved. http://dx.doi.org/10.1053/j.jfas.2016.03.002 Contents lists available at ScienceDirect The Journal of Foot & Ankle Surgery journal homepage: www.jfas.org The Journal of Foot & Ankle Surgery xxx (2016) 1–4