A Lisfranc injury involves a disruption of the midfoot joint complex, specifically where the metatarsal bones connect to the smaller tarsal bones. This area is stabilized by a network of ligaments, including the strong Lisfranc ligament, which is integral to maintaining the foot’s arch. When this complex is fractured, dislocated, or severely sprained, the structural integrity of the entire foot is compromised. Surgery is frequently necessary for unstable injuries to restore the precise anatomical alignment of the joints and ensure proper function. Understanding the length of the operation is only one aspect of the overall treatment timeline, which extends over many months.
Understanding the Surgical Approaches
The choice of surgical technique influences the procedure’s complexity and duration, with two primary methods available for addressing Lisfranc injuries. Open Reduction and Internal Fixation (ORIF) is the traditional approach, involving surgically realigning displaced bones into their correct anatomical position. The surgeon uses temporary hardware, such as screws and plates, to hold the joint in place while ligaments and bones heal. The goal of ORIF is to preserve the natural motion of the midfoot joints.
The alternative is Primary Arthrodesis, which involves surgically fusing the damaged midfoot joints permanently. This technique is reserved for more severe injuries, such as those with significant cartilage damage or highly comminuted fractures. Fusion eliminates movement in the affected joints, preventing post-traumatic arthritis. While arthrodesis is generally more time-consuming than simple fixation, it often yields better long-term functional outcomes for certain injury patterns.
The Actual Procedure Duration
The direct time a surgeon spends operating is only one component of the total time a patient is in the surgical setting. The actual operative time for a Lisfranc procedure typically ranges from 90 minutes to 3 hours. This duration depends highly on the extent of the injury and the surgical approach employed. A straightforward ORIF procedure is shorter, while a multi-joint primary arthrodesis takes longer due to the steps required for joint surface preparation and fusion.
The patient’s total time within the operating room suite, from entry to transfer to the post-anesthesia care unit, is considerably longer, often lasting between 2.5 and 4 hours. This non-operative time accounts for anesthesia administration, careful patient positioning, sterile preparation, and the final dressing and application of a splint. This extended timeline ensures the patient is safely monitored and stabilized throughout the perioperative period.
Factors That Affect Procedure Length
The variation in operative time reflects several variables unique to the patient and the injury itself. The most influential factor is the severity and pattern of the injury, including the number of tarsometatarsal joints involved and the degree of bone fragmentation. Injuries requiring reconstruction of multiple joint columns or involving significant ligamentous instability naturally extend the surgical time. A complex injury may also necessitate a staged approach, where temporary fixation is placed first to allow soft tissue swelling to subside before the definitive procedure.
The choice of fixation method also plays a role. If a bone graft is necessary to promote fusion during arthrodesis, the time required to harvest or prepare the graft material is added to the total operative time. Associated complications, such as compartment syndrome, may require an immediate, separate surgical decompression procedure, further complicating the timeline. The experience level of the surgical team and the facility’s logistical flow also contribute to the final duration.
The Comprehensive Recovery Period
While the operation takes a few hours, the commitment to recovery is a long-term undertaking that requires patience. The initial period requires strict non-weight bearing (NWB) for approximately six to eight weeks, which is necessary to allow the bone and ligaments to heal without stress. During this phase, the foot is immobilized in a cast or boot, and mobility is managed using crutches or a knee scooter.
Following the initial NWB phase, the patient gradually transitions to partial weight bearing (PWB) in a protective boot, often beginning around the six to twelve-week mark. Formal physical therapy begins at this time, focusing on restoring the foot’s range of motion, strength, and proprioception. Returning to walking without an assistive device and resuming normal daily activities can take three to six months.
A full return to strenuous activities or sports often extends the timeline to nine to twelve months from the date of the initial surgery. If the patient underwent ORIF, a second, minor surgical procedure to remove the hardware is typically performed after primary healing is complete, usually four to six months post-surgery. This hardware removal is a shorter, often outpatient procedure, and while it requires a brief period of restricted weight bearing, it is a small fraction of the time commitment of the initial operation.