Functional Outcomes of Primary Arthrodesis (PA) Versus Open Reduction and Internal Fixation (ORIF) in the Treatment of Lisfranc Injuries

Aneja, Arun; Gal, Zsombor; Dawson, Ashley N; Sneed, Chandler R; Kalbac, Tyler; Pectol, Richard W; Kavolus, Matthew W; Griffin, Jarod T.; Leonard, Elizabeth H; Foster, Jeffrey A; Kinchelow, Daria L; Srinath, Arjun

doi:10.1097/bot.0000000000002606

Cited by 1 publication

(4 citation statements)

References 21 publications

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“…This category includes 6 outcomes across 5 studies. 3,6,21,23,40 The majority of studies were statistically fragile, and only 1 study supporting no difference between ORIF and PA was found to be statistically robust. In Buda et al, 6 reoperation rates were not statistically significant between ORIF and PA with a CFI of 8 and LTF of 0.…”

Section: Discussionmentioning

confidence: 98%

“…Many outcomes indicated no significant difference between ORIF- and PA-managed injuries. 3,20,21,23 For example, Hawkinson et al 20 found no significant difference in “return to duty” with a robust FI of 8 and no loss to follow up in a retrospective study of 171 active duty military participants. Henning et al 21 similarly found no statistical difference in requirement of assistive device for ambulation at final follow-up between ORIF and PA with a CFI of 10 and LTF of 8.…”

Section: Discussionmentioning

confidence: 99%

“…9 However, ORIF has been associated with more surgeries predominantly for hardware removal or secondary fusion. 3,20,21,23 Given the current lack of consensus, there is a need to evaluate the relative merits of previous studies and determine how these results should impact clinical decision making. Although P values are commonly used to demonstrate statistical significance, these values can be misleading because of the impact of study design and power.…”

Section: Introductionmentioning

confidence: 99%

“…9 However, ORIF has been associated with more surgeries predominantly for hardware removal or secondary fusion. 3,20,21,23…”

Section: Introductionmentioning

confidence: 99%

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

Ahn,

Quinn,

Zhao

et al. 2024

Foot Ankle Int.

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Background: There is a lack of consensus in the use of open reduction internal fixation (ORIF) vs primary arthrodesis (PA) in the management of Lisfranc injuries. Statistical fragility represents the number of events needed to flip statistical significance and provides context to interpret P values of outcomes from conflicting studies. The current study evaluates the statistical fragility of existing research with an outcome-specific approach to provide statistical clarity to the ORIF vs PA discussion. We hypothesized that statistical fragility analysis would offer clinically relevant insight when interpreting conflicting outcomes regarding ORIF vs PA management of Lisfranc injuries. Methods: All comparative studies, RCTs, and case-series investigating ORIF vs PA management of Lisfranc injuries published through October 5, 2023, were identified. Descriptive characteristics, dichotomous outcomes, and continuous outcomes were extracted. Fragility index and continuous fragility index were calculated by the number of event reversals needed to alter significance. Outcomes were categorized by clinical relevance, and median FI and CFI were reported. Results: A total of 244 studies were screened. Ten studies and 67 outcomes (44 dichotomous, 23 continuous) were included in the fragility analysis. Of the 10 studies, 4 studies claimed PA to correlate with superior outcomes compared to ORIF with regard to functional scores and return to function outcomes. Of these 4 studies, 3 were statistically robust. Six studies claimed PA and ORIF to have no differences in outcomes, in which only 2 studies were statistically robust. Conclusion: The overall research regarding ORIF vs PA is relatively robust compared with other orthopaedic areas of controversy. Although the full statistical context of each article must be considered, studies supporting PA superiority with regard to functional scores and return to function metrics were found to be statistically robust. Outcome-specific analysis revealed moderate fragility in several clinically relevant outcomes such as functional score, return to function, and wound complications.

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