A systematic review and meta-analysis of the treatment of acute lisfranc injuries: Open reduction and internal fixation versus primary arthrodesis

Alcelik, Ilhan; Fenton, Carl; Hannant, G; Abdelrahim, Musaab; Jowett, Charlie; Budgen, Adam; Stanley, James

doi:10.1016/j.fas.2019.04.003

Cited by 27 publications

(28 citation statements)

References 23 publications

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“…However, no significant differences were identified for patient outcome scores. 3,34,59 The major criticism of the studies included in these systematic reviews and meta-analyses are that all manner of Lisfranc injuries are included to bolster the study power. However, the increased heterogeneity does confound the data.…”

Section: Treatmentmentioning

confidence: 99%

Updates on Lisfranc Complex Injuries

Yan

Chen

et al. 2021

Foot & Ankle Orthopaedics

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Lisfranc injuries are a disruption of one or more of the tarsometatarsal joints and have an estimated incidence of 1/55 000 people. However, the total number of Lisfranc injuries could be underreported, because almost 20% of these injuries are initially missed. Because of the relative infrequency of these injuries, the current literature is inconsistent in regard to proper treatment. This article provides a review of Lisfranc complex injuries including relevant anatomy, diagnosis, treatment, classifications, operative approaches, and outcomes and complications. Based on existing evidence, it also proposes an algorithm the authors prefer for the evaluation and treatment of Lisfranc complex injuries.

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Section: Treatmentmentioning

confidence: 99%

Updates on Lisfranc Complex Injuries

Yan

Chen

et al. 2021

Foot & Ankle Orthopaedics

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“… 23 Additionally, some authors reported avulsion fractures as purely ligamentous injuries, which might also influence the results. 3 , 8 , 12 , 14…”

Section: Discussionmentioning

confidence: 99%

Lisfranc injuries: fix or fuse?

et al. 2021

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Aims This systematic review and meta-analysis was conducted to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA) in the treatment of Lisfranc injuries, regarding patient-reported outcome measures (PROMs), and risk of secondary surgery. The aim was to conclusively determine the best available treatment based on the most complete and recent evidence available. Methods A systematic search was conducted in PubMed, Cochrane Controlled Register of Trials (CENTRAL), EMBASE, CINAHL, PEDro, and SPORTDiscus. Additionally, ongoing trial registers and reference lists of included articles were screened. Risk of bias (RoB) and level of evidence were assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The random and fixed-effect models were used for the statistical analysis. Results A total of 20 studies were selected for this review, of which 12 were comparative studies fit for meta-analysis, including three randomized controlled trials (RCTs). This resulted in a total analyzed population of 392 patients treated with ORIF and 249 patients treated with PA. The mean differences between the two groups in American Orthopedic Foot and Ankle Society (AOFAS), VAS, and SF-36 scores were -7.41 (95% confidence interval (CI) -13.31 to -1.51), 0.77 (95% CI -0.85 to 2.39), and -1.20 (95% CI -3.86 to 1.46), respectively. Conclusion This is the first study to find a statistically significant difference in PROMs, as measured by the AOFAS score, in favour of PA for the treatment of Lisfranc injuries. However, this difference may not be clinically relevant, and therefore drawing a definitive conclusion requires confirmation by a large prospective high-quality RCT. Such a study should also assess cost-effectiveness, as cost considerations might be decisive in decision-making. Level of Evidence: I Cite this article: Bone Jt Open 2021;2(10):842–849.

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“…26,29 Recent meta-analysis, which compare relatively fewer studies support our conclusion that primary arthrodesis may result in better AOFAS scores and less pain although these articles lack definitive conclusions on complication rates and are not included as comprehensive breadth of information. 36-38 No consensus has emerged regarding the treatment of Lisfranc injuries, though it is generally agreed upon that closed reduction and casting is unsuccessful for most cases. 23,28,34…”

Section: Discussionmentioning

confidence: 99%

Arthrodesis or Open Reduction Internal Fixation for Lisfranc Injuries: A Meta-analysis

Levy¹,

Yatsonsky

Moral

et al. 2020

Foot & Ankle Specialist

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The purpose of this study is to determine if arthrodesis, compared with open reduction and internal fixation (ORIF), produces favorable American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores, and to determine if differences in complication, revision surgery, and secondary arthrodesis rates exist for patients with Lisfranc fracture/dislocation injuries. Searches were performed in PubMed using the keywords “Lisfranc fracture,” “metatarsal fracture,” “ORIF,” “open reduction internal fixation,” “arthrodesis,” and “fusion.” These criteria left 183 articles for review. Exclusions left 21 articles and 2 translations of Chinese abstracts. Data analysis was performed using Student’s 2-sample t test for samples of equal variance, and chi-square test for goodness of fit. The t test revealed a significant difference ( P = .03) between the average AOFAS score for patients who underwent primary arthrodesis (84.7 ± 6.14) compared with those who were treated with ORIF (78.9 ± 5.09). There was no significant difference for the average VAS scores ( P = .33) of the arthrodesis and ORIF groups. The complication rate of arthrodesis patients was significantly lower than ORIF patients ( P = .04), and the rates of revision surgery ( P = .22) and secondary arthrodesis ( P = .53) were not significant between the groups. The results of this study indicate that arthrodesis may be a better surgical option than ORIF, due to the higher functional scores and the lower complication rate. Levels of Evidence: Level III: A meta-analysis

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A systematic review and meta-analysis of the treatment of acute lisfranc injuries: Open reduction and internal fixation versus primary arthrodesis

Cited by 27 publications

References 23 publications

Updates on Lisfranc Complex Injuries

Updates on Lisfranc Complex Injuries

Lisfranc injuries: fix or fuse?

Arthrodesis or Open Reduction Internal Fixation for Lisfranc Injuries: A Meta-analysis

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