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Background <p>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.</p> Methods <p>This retrospective cohort study included 21 pediatric patients with radiographically confirmed Lisfranc injuries treated surgically (<i>n</i> = 8) or nonoperatively (<i>n</i> = 13). Functional outcomes were assessed at final follow-up using the American Orthopaedic Foot &amp; 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.</p> Results <p>Injury severity differed between groups (<i>p</i> = 0.013). Nonoperative treatment was associated with higher AOFAS scores (mean difference 15.65; 95% CI 8.83–22.65; g = 2.14; <i>p</i> = 0.0006) and lower VAS scores (mean difference − 2.80; 95% CI − 3.88 to − 1.69; g = − 2.31; <i>p</i> = 0.0005). PedsQL scores were also higher following nonoperative treatment (mean difference 17.06; 95% CI 3.78–32.44; g = 1.17; <i>p</i> = 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.</p> Conclusion <p>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.</p> Level of evidence <p>Level III, retrospective comparative study.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月14日

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  • Nezih Ziroglu,
  • Ali Can Koluman,
  • Basar Burak Cakmur,
  • Altug Duramaz,
  • Cemal Kural,
  • Emre Baca

摘要

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.