Introduction. Lisfranc joint injuries are increasingly recognised in elite soccer and rugby players. Currently no evidence-based guidelines exist on timeframes for return to training and competition following surgical treatment. This study aimed to see whether return to full competition following surgery for Lisfranc injuries was possible in these groups and to assess times to training, playing and possible related factors. Material/Methods. Over 46-months, a consecutive series of fifteen professional soccer (6) and rugby(9) players in the English Premierships/Championship, was assessed using prospectively collected data. All were isolated injuries, sustained during competitive matches. Each had clinical and radiological evidence of injury and was treated surgically within thirty-one days. A standardised postoperative regime was used. Results. Follow-up was obtained in all fifteen cases. Eight cases were ligamentous injuries and seven were bony. Time from injury to fixation ranged from 10–31 days. One athlete retired following a ligamentous injury. All remaining fourteen returned to training and full competition. Excluding the retired case, mean return to training time was 20.2 weeks and to full competition was 25.6 weeks. No significant difference existed between the mean return to competition time for rugby (27.8 weeks) and soccer(24.7 weeks). A significant difference existed between the mean return to competition time for ligamentous (23.7 weeks) compared to bony(27.6 weeks) injuries(p = 0.012). Three patients suffered deep peroneal nerve sensation loss, two of which fully recovered. Discussion/Conclusion. Return to competitive elite-level soccer and rugby is possible following surgically treated Lisfranc injuries. Return to training can take up to 24 weeks and playing up to 31 weeks, with bony injuries taking longer. To our knowledge this is the largest series of its kind and whilst we recognise it contains small numbers, we feel it provides some guidance on rehabilitative timeframes for those who treat and those who sustain these injuries. Evidence Level: 4

Aims

The primary objective was to determine the incidence of COVID-19 infection and 30-day mortality in patients undergoing foot and ankle surgery during the global pandemic. Secondary objectives were to determine if there was a change in infection and complication profile with changes introduced in practice.

Most of the literature on surgical site infections following the surgical treatment of fractures of the ankle is based on small series of patients, focusing on diabetics or the elderly. None have described post-operative functional scores in those patients who develop an infection. We performed an age- and gender-matched case–control study to identify patient- and surgery-related risk factors for surgical site infection following open reduction and internal fixation of a fracture of the ankle. Logistic regression analysis was used to identify significant risk factors for infection and to calculate odds ratios (OR). Function was assessed using the Olerud and Molander Ankle Score. The incidence of infection was 4% (29/717) and 1.1% (8/717) were deep infections. The median ankle score was significantly lower in the infection group compared with the control group (60 vs 90, Mann–Whitney test p < 0.0001). Multivariate regression analysis showed that diabetes (OR = 15, p = 0.031), nursing home residence (OR = 12, p = 0.018) and Weber C fractures (OR = 4, p = 0.048) were significant risk factors for infection.

A low incidence of infection following open reduction and internal fixation of fractures of the ankle was observed. Both superficial and deep infections result in lower functional scores.

Cite this article: Bone Joint J 2014;96-B:636–40.