A Comparison of Complications and Reoperations Between Open Reduction and Internal Fixation Versus Primary Arthrodesis Following Lisfranc Injury

Abstract

There is a lack of consensus in the literature regarding optimal treatment methods for Lisfranc injuries, and recent literature has emphasized the need to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA). The purpose of the current study is to compare reoperation and complication rates between ORIF and PA following Lisfranc injury in a private, outpatient, orthopaedic practice. A retrospective chart review was performed on patients undergoing operative intervention for Lisfranc injury between January 2009 and September 2015. A total of 196 patients met the inclusion criteria (130 ORIF, 66 PA), with a mean follow-up of 61.3 and 81.7 weeks, respectively. The ORIF group had a higher reoperation rate than the PA group, due to hardware removal. When hardware removals were excluded, the reoperation rate was similar. Postsurgical complications were compared between the 2 groups with no significant difference. In conclusion, ORIF and PA had similar complication rates. When hardware removals were excluded, the reoperation rates were similar, although hardware removals were more common in the ORIF group compared with the PA group. Levels of Evidence: Level III

Inconsistent radiographic diagnostic criteria for Lisfranc injuries: a systematic review

“…1st cuneiform to 2nd metatarsal diastasis was the second most common diagnostic criteria in the anteroposterior view and was employed in eight studies [29,32,36,37,40,41,43,44]. Medial column alignment was reported in six studies [19,29,32,[40][41][42]. The eck sign was fully employed in three studies [17,20,22] but mixed in three more other studies [23,28,34], and the notch sign was employed in one study [24].…”

“…Oblique View 3rd cuneiform to 3rd metatarsal [19,21,27,31,[42][43][44] and cuboid to 4th metatarsal subluxation [19,21,23,31,[42][43][44] were both the radiographic diagnostic criteria observed in the oblique view and employed in seven studies each.…”

“…The talometatarsal angle [21,24,27,39,40,43,44] and longitudinal arch height [19,20,24,36,39,43,44] were the most common radiographic diagnostic criteria in the lateral view, as employed in seven studies each. Cuneiform-metatarsal malalignment was employed in six studies [19,21,24,31,41,42].…”

Statistical Fragility Analysis of Open Reduction Internal Fixation vs Primary Arthrodesis to Treat Lisfranc Injuries: A Systematic Review

“…One must use caution in interpreting these results as the study was severely underpowered with retention of only 32 of 60 patients needed to meet their predetermined benchmark for statistical power. Finally, So et al 40 reported that PA had a significantly longer time to weightbearing than ORIF. However, further analysis revealed that the difference was 0.7 days, which brings into question the clinical relevance of this finding.…”

Management of Lisfranc Injuries

“…In those patients treated with IF, 46% (n = 11) developed post-traumatic degenerative changes in the first TMTJ, but only 1 patient required secondary arthrodesis. So et al performed a retrospective study comparing complications and reoperation rates in 130 patients treated with IF and 66 patients treated with PA 85 . The reoperation rate was significantly higher in the fixation group (78% vs. 20%), but when hardware removal cases were excluded, the reoperation rates were comparable, as were the overall complication rates.…”