Removal of Metalwork After Lisfranc Fracture-Dislocation Internal Fixation: A Retrospective Study from a Major Trauma Centre with More Than 2 Years of Follow-Up.

Purpose: Lisfranc injuries are considered rare but significant injuries. There are debates about the best treatment approach, and removal of metalwork is one of them. This study aims to compare the functional outcomes and complications of patients who had the removal of metalwork after Lisfranc fixation and those who retained it.

Materials and methods: This study was a retrospective review of patients admitted from 01/01/2017 to 31/07/2020 at University Hospitals of Southampton NHS Foundation Trust, UK, who had internal fixation for Lisfranc injuries. Group A were patients who had retained metalwork, and group B were patients who had metalwork removed. In subgroup B1, removal of metalwork was planned, whilst this was unplanned in subgroup B2. The primary outcome was the Manchester-Oxford Foot Questionnaire (MOXFQ) at the final follow-up. The secondary outcome was the rate of complications.

Results: Initial search showed 124 patients. Forty-two patients were included in the study after the exclusion. The average age was 44.6 years (range 19-77 years; SD 15.4). The average follow-up was 57 months (range 33-78 months; SD 14). Eighteen patients (43%) responded to the final telephone appointments for MOXFQ. There was no statistically significant difference in all domains and the Index of MOXFQ between both groups. Relative risks were 0.16 to 2.38 across the range of complications, but none of them was statistically significant (p = 0.14-0.86).

Conclusion: We conclude that there was no functional difference between removal and retention of metalwork in Lisfranc fracture dislocation. We recommend removal of metalwork only if indicated. Close follow-up is necessary for the patients to assess the potential complications.