This is a plain-English translation of the academic paper above, prepared for patients, referring clinicians, and other non-specialist readers. It preserves the structure of the original paper while removing technical jargon. For the full clinical paper, follow the PubMed or DOI links.
Background
How patients fared in the medium term after a serious midfoot injury (a Lisfranc injury) was repaired using a dorsal bridge plate — a metal plate laid across the top of the foot — and whether that plate could be safely left in place rather than routinely removed in a second operation. We studied 85 adult patients treated at a major trauma centre.
Rationale
Lisfranc injuries dislocate the joints in the middle of the foot and need surgical realignment to give the patient any chance of pain-free walking. Dorsal bridge plating is favoured because it is rigid and avoids fusing the joints. The traditional teaching has been to remove the plate after a few months, but this means a second operation, with its own risks and costs. We wanted to know whether leaving the plate in produces comparable results.
Results
At an average follow-up of 40 months, patient-reported foot scores (MOXFQ and AOFAS) were comparable to those reported in other published series where the plate was routinely removed. Patients whose injury also involved a fracture into the joint surface did less well. Only 21% of patients ultimately needed plate removal — commonly because of prominence or stiffness — meaning roughly four out of five avoided a second operation. Female patients were significantly more likely to need removal. 9% eventually needed a fusion of the joint for arthritis.
Implications
For most patients having dorsal bridge plate fixation of a Lisfranc injury, the plate can be left in unless and until it causes a problem — sparing them a second operation. Patients whose injuries involve the joint surface should expect a slower or less complete recovery. The presence of intra-articular damage is the main predictor of a poorer functional outcome.
Source: Onochie EI, Bua N, Patel A, Jha S, Heidari N, Vris A, Parker L, Malagelada F, Jeyaseelan LA. Functional Outcomes of Dorsal Bridge Plating for Lisfranc Injuries with Routine Metalwork Retention: A Major Trauma Centre Experience. Foot & Ankle Orthopaedics 2022. doi:10.1177/2473011421s00383
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