Staged management of high-energy Lisfranc injuries with temporary fixation: A systematic review of post-operative outcomes

We assessed the impact of temporary stabilization on outcomes in the management of high-energy Lisfranc injuries through a systematic review. Studies were included if they reported post-operative complications or patient-reported outcomes following external fixation or percutaneous pinning before delayed definitive fixation. The search yielded 227 records through databases and 12 through manual identification. After screening, 19 studies underwent full-text review, with six included in the final analysis. Data from six eligible studies comprising 147 patients were extracted and analyzed using descriptive synthesis and limited random-effects meta-analysis for pooled complication rates. This review protocol was registered with The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42025631978). Of the 147 patients, 122 underwent temporary stabilization while 25 did not. Most patients were males (66.7%) with a mean age of 43.4 years. Acute post-operative complications occurred in 11.6% of patients, all within the temporized cohort. Post-traumatic arthritis (PTOA) was more frequently reported in temporized patients (13.9%) than in those without temporization (8%), although follow-up duration varied substantially across studies. Pooled mean patient-reported outcomes showed a mean post-operative Visual Analog Scale (VAS) of 2.44 and an American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score of 77.56. Patients receiving temporary stabilization showed numerically lower post-operative pain and higher functional scores (VAS 2.16; AOFAS 79.67) compared with patients without temporization (VAS 3.20; AOFAS 71.71). Temporary stabilization before definitive fixation was associated with higher acute complication rates but comparable or modestly improved functional outcomes. These findings should be interpreted cautiously, given heterogeneity in follow-up, outcome definitions, and confounding by injury severity.