Lisfranc injury - internet resources / decision making process

Below is a list of other internet resources worth reading if you have a lisfranc injury:

http://orthoinfo.aaos.org/topic.cfm?topic=A00162

http://www.aafp.org/afp/1998/0701/p118.html

http://www.orthobullets.com/foot-and-ankle/7030/lisfranc-injury-tarsometatarsal-fracture-dislocation

http://emedicine.medscape.com/article/1236228-overview

One advantage of fusion vs. ORIF is that the procedure no longer needs to be performed urgently.
A fusion can be performed at almost anytime after the injury.  One caveat is the severity of the injury.  Another caveat is that patients who wait greater than 1 year - seem to have a worse outcome.  At present, the optimal time to perform surgery seems to be within 4 months of injury.

This is good for several reasons:

1) The patient can plan when they want to have the fusion.  This gives the patient time to plan ahead in regards to work, child care, transportation and housing arrangements.

2) The patient and surgeon are convinced that they are dealing with a true lisfranc injury.  If you have a simple metatarsal fracture this should heal within 6 to 12 weeks.  However, if the pain does not get better in this time period, and you have separation at the lisfranc ligament, there is a possibility that you have a lisfranc injury.

3) Swelling in the foot and wound closure is no longer an issue.

4) Non-operative management has been exhausted.  Approximately 30% of patients referred for a Lisfranc injury do well with non-operative management.

5) You can take the time to find an Orthopaedic Surgeon who specializes in Foot and Ankle Surgery to perform your surgery.  This is especially true if you proceed with a Lisfranc fusion procedure.  A Lisfranc fusion procedure is a surprisingly technical operation that is difficult to perform well.

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