Primary arthrodesis versus open reduction internal fixation for complete Lisfranc fracture dislocations: a retrospective study comparing functional and radiological outcomes

Abstract

BackgroundThe aims of this retrospective study were to compare the functional and radiological outcomes of primary arthrodesis and open reduction internal fixation (ORIF) for the treatment of complete Lisfranc fracture dislocations.MethodsA retrospective cohort study of 39 patients treated for a complete Lisfranc fracture dislocation, defined as Myerson types A and C2, over a period of 8 years at a level 1 trauma centre was performed. Of these, 18 underwent primary arthrodesis, and 21 ORIF. The primary outcome measures included the American Orthopaedic Foot and Ankle Society score, the validated Manchester Oxford Foot Questionnaire functional tool, and the secondary outcome was the radiological Wilppula classification of anatomical reduction.ResultsSignificantly better functional outcomes were seen in the primary arthrodesis group. These patients had a mean Manchester Oxford Foot Questionnaire score of 30.1 points, compared with 45.1 for the ORIF group (P = 0.017). Similarly, the mean American Orthopaedic Foot and Ankle Society score was 71.8 points in the fusion group versus 62.5 in the ORIF group (P = 0.14). Functional outcome was dependent on the quality of final reduction (P < 0.001). Primary arthrodesis achieved good initial reduction in 83% cases compared to 62% with ORIF (P = 0.138). There was a loss of reduction quality of 47% in the ORIF group over time.ConclusionPrimary arthrodesis for complete Lisfranc fracture dislocations resulted in improved functional outcomes and quality of reduction compared to open reduction and internal fixation.

Lisfranc injuries: fix or fuse?

“…Patients who underwent ORIF had a risk ratio of 1.53 (95% CI 1.15 to 2.03) for hardware removal, compared to PA. 5 , 6 , 8 , 15 , 23 , 25 , 26 No difference was found in revision surgery (RR 2.23 (95% CI 0.94 to 5.32)). 5 , 6 , 8 , 15 , 16 , 23 , 25 , 26 Heterogeneity for hardware removal surgery and revision surgery was 65% and 5%, respectively ( Figure 1 ).…”

“… 6 , 15 , 16 , 23 Analysis of hardware removal on indication did not show a significant difference. 5 , 8 , 25 , 26 No significant difference was found for secondary surgery without implant removal. However, one of the presumed advantages of PA is to prevent post-traumatic arthritis and the consequent need for SA.…”

“…A total of 20 studies were selected for this study ( Figure 2 ). The meta-analyses included the comparative studies: three RCTs, 8 , 15 , 23 one nRCT, 4 and eight retrospective case series, 5 , 6 , 16 , 22 , 24 - 27 resulting in a total of 392 patients treated by ORIF and 249 by PA. Seven non-comparative case studies reporting on ORIF and one on PA were used for a descriptive analysis to further expand our dataset.…”

“… 4 Traditionally, arthrodesis of the midfoot was seen as a salvage procedure for complicated outcome of Lisfranc injuries. 4 , 5 However, more recent studies have reported good patient-reported outcomes after arthrodesis as primary treatment. 6 - 8 …”

Radiographic outcomes of cortical screw fixation as an alternative to Kirschner wire fixation for temporary lateral column stabilization in displaced Lisfranc joint fracture-dislocations: a retrospective cohort analysis

“…With 2 years of follow up, they found arthrodesis patients to have 92% of their pre-injury function, while internal fixation patients had 65% of their pre-injury function [ 15 ]. A 2019 Australian case series of 39 patients with osseous Lisfranc fracture-dislocations suggests improved outcomes with primary arthrodesis of the medial and middle columns when compared to ORIF in patients with totally incongruous TMT joint injuries (Myerson types A and C2) [ 16 ]. Temporary lateral column fixation was performed with K-wires in 80.9% of the ORIF group and 55.6% of the arthrodesis group [ 16 ].…”