Operative Management of Lisfranc Injuries

Preoperative and Intraoperative Considerations

The American Academy of Orthopaedic Surgeons recommends prophylactic antibiotics administered prior to incision, such as cefazolin, for extremity trauma in patients with Lisfranc injuries 1
Left foot prepped and draped in standard sterile fashion, with fluoroscopic stress examination performed to identify all components of instability in patients with Lisfranc injuries 1
No evidence of open fracture or neurovascular compromise was found in patients with Lisfranc injuries 1
The American Academy of Orthopaedic Surgeons suggests that the surgical team, including the surgeon, assistant, anesthesiologist, and scrub nurse, should be experienced in managing Lisfranc injuries 1

The American Academy of Orthopaedic Surgeons recommends elevation of the extremity to minimize swelling, and pain management as appropriate, in the postoperative period for patients with Lisfranc injuries 1
Prophylactic antibiotics may be indicated in the postoperative period for patients with Lisfranc injuries, as suggested by the World Journal of Emergency Surgery 2, 3
Physical therapy should be initiated after K-wire removal, approximately 6-8 weeks post-surgery, to optimize functional outcomes in patients with Lisfranc injuries 1
The American Academy of Orthopaedic Surgeons recommends regular radiographic assessment to monitor reduction and healing, with monitoring for complications including posttraumatic arthritis, which occurs in approximately 25% of cases despite anatomic reduction 1

Initial evaluation should include weightbearing radiographs of the foot when possible, as non-weightbearing radiographs are not reliable for detecting subtle injuries 4
MRI has high correlation with intraoperative findings for unstable Lisfranc injuries, particularly in cases where radiographs are negative but clinical suspicion remains high 5, 6
CT is particularly valuable in acute hyperflexion injuries and high-energy polytrauma, providing detailed imaging of the foot and ankle 6, 7

The American College of Radiology recommends achieving optimal anatomic reduction and ensuring stability of the tarsometatarsal joints, particularly the first, second, and third, to directly impact outcomes 5
Failure to achieve anatomic reduction can lead to post-traumatic arthritis, foot deformities, and significant disability, highlighting the importance of proper surgical management 5