Functional and radiographic outcomes after operative and nonoperative treatment of pediatric Lisfranc injuries

Abstract

Background Pediatric Lisfranc injuries are rare and frequently misdiagnosed, potentially resulting in delayed treatment and long-term morbidity. Evidence guiding surgical versus nonoperative management in children remains limited.Methods This retrospective cohort study included 21 pediatric patients with radiographically confirmed Lisfranc injuries treated surgically (n = 8) or nonoperatively (n = 13). Functional outcomes were assessed at final follow-up using the American Orthopaedic Foot & Ankle Society-Midfoot Function Score (AOFAS-MFS), Pediatric Quality of Life Inventory (PedsQL), and visual analog scale (VAS). Radiographic alignment parameters were measured on weight-bearing radiographs. Between-group differences were analyzed using nonparametric tests. Effect sizes (Hedges g) and 95% bootstrap confidence intervals (CI) were reported. Multivariable regression models adjusted for injury severity (Nunley-Vertullo grade), age, and time to presentation.Results Injury severity differed between groups (p = 0.013). Nonoperative treatment was associated with higher AOFAS scores (mean difference 15.65; 95% CI 8.83-22.65; g = 2.14; p = 0.0006) and lower VAS scores (mean difference - 2.80; 95% CI - 3.88 to - 1.69; g = - 2.31; p = 0.0005). PedsQL scores were also higher following nonoperative treatment (mean difference 17.06; 95% CI 3.78-32.44; g = 1.17; p = 0.0176). After adjustment, surgical treatment remained independently associated with lower AOFAS and higher VAS scores. In the predefined exploratory Grade 2 subgroup, patients treated nonoperatively demonstrated higher functional scores, whereas radiographic parameters were comparable between groups.Conclusion In this retrospective cohort, patients treated nonoperatively demonstrated higher functional scores and lower pain at mid-term follow-up, including within the exploratory Grade 2 subgroup. However, these findings should not be interpreted as evidence of treatment superiority because of the observational design, severity-based treatment allocation, and limited sample size. Nonoperative treatment may be considered in carefully selected pediatric patients without clear instability, but prospective multicenter studies are needed to define pediatric-specific treatment thresholds.Level of evidence Level III, retrospective comparative study.