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

SLR - April 2022 - Elliot Olenchek

Reference: So E, Lee J, Pershing ML, Chu AK, Wilson M, Halaharvi C, Mandas V, Hyer CF. A Comparison of Complications and Reoperations Between Open Reduction and Internal Fixation Versus Primary Arthrodesis Following Lisfranc Injury. Foot Ankle Spec. 2021 Nov 28:19386400211058264. doi: 10.1177/19386400211058264. Epub ahead of print. PMID: 34841938.

Level of Evidence: III

Scientific Literature Review

Reviewed By: Elliot Olenchek, DPM
Residency Program: Inova Fairfax Medical Campus – Falls Church, VA

Podiatric Relevance: To fix or to fuse? This question is ubiquitous within the discussion of treating the Lisfranc injury. The article discussed below touches on just this comparing the two treatment modalities through a myriad of clinical outcomes. The applicability of this article lies within their findings in relation to the lack of consensus within literature.

Methods: Retrospective chart review from January 2009 to September 2015 at one Foot & Ankle Orthopedic Center of 196 patients. Of these patients, 130 were treated with ORIF and 66 with Primary Arthrodesis. Exclusion criteria included previous joint infection, PAD, diabetes with neuropathy, bilateral surgery on same date, less than 12 month follow up and open Lisfranc. Outcomes included patient demographics, post-surgical complications (Infection, post traumatic arthritis, malalignment, hardware, DVT, etc.), time to weightbearing, fixation type, reoperation rate, and revision. Secondary outcome measures included radiographic outcomes (time to fusion/quality of reduction).

Results: Analyzing patient demographics there were statistical differences found between the 196 patients. These included the PA group having more diabetes, osteoporosis and older age. There were no differences in smoking, RA or mean follow up. Intraoperatively, OR times were longer in the PA group by almost thirty minutes but no difference in PACU time. Hardware varied as well including more use of staples in combination with plates and screws in the PA group. When analyzing postoperatively, reoperation rates were greater in the ORIF group by almost 60 percent (77 percent to 19 percent). However, when excluding hardware removal cases this left the rates at ORIF, 3.9 percent and PA 4.6 percent. Time to weight bearing was also significant 6.4 weeks to 7.1 (p<.003), respectively. There were no significant differences in post-surgical complications or radiographic outcomes.

Conclusions: When inspecting this large population of low energy Lisfranc injuries in a private, outpatient, orthopedic setting it can be inferred that there may not be a superior treatment method between ORIF or PA. Both treatment options had a similar complication rate and reoperation rate excluding hardware removal. Therefore, if the Foot & Ankle Surgeon is not deterred to repeat an operation on the patient for removal, ORIF is certainly a token option for this injury. Improvements in this study or areas of future exploration could include analysis of pre-post activity levels, low vs. high energy or cost benefit analysis.