SLR - December 2014 - Laura Bohman
Reference: Hu SJ, Chang SM, Li XH, & Yu GR (2014). Outcome comparison of Lisfranc Injuries Treated Through Dorsal Plate Fixation Versus Screw Fixation. Acta Ortop Bras.[online], 22(6), 315-20.Scientific Literature Review
Reviewed By: Laura Bohman, DPM
Residency Program: Cambridge Health Alliance
Podiatric Relevance: Conservative treatment for Lisfranc injuries can be associated with chronic arthritis, pain, and residual functional disability. Injury to this joint is usually associated with need for surgical repair. This is largely due to difficulty in the ability to close reduce and stabilize the deformity. Many techniques of internal stabilization have been studied in order to find improved outcomes and decreased long term dysfunction. Previous literature has shown open reduction internal fixation with trans-articular screws to provide excellent stability, but this also has been associated with long term arthritis and chronic pain. The article cites studies by Ly and Coetzee who have found better long term outcomes with primary fusion. The purpose of this study was to see if a better outcome was possible by ORIF through dorsal plating versus trans-articular screws.
Methods: Sixty-two patients were admitted with Lisfranc injuries and sixty underwent surgical intervention. Inclusion criteria required the patient to be an adult with a Lisfranc injury that was ligamentous and/or osseous. Exclusion criteria included pathologic fracture, polytrauma, and/or severe associated co-morbidity. The patients were divided into two groups with group 1 using dorsal plate fixation and group 2 with trans-articular screw. The article did not disclose how the groups were chosen. For group 1, one or more plates were used base on severity and were created with a linear incision in the intermetatarsal spaces. The plates were removed six to eight months after the initial surgery. The stepwise fixation, using trans-articular screws, was not described. Post-operatively all patients were treated in the same manner. The patients were non-weight bearing for the first 6-8 weeks followed by full weight bearing in a protective boot and initiation of physical therapy.
Results: In group one and two there was a evenly divided range of severity of trauma according to the Myerson classification. These patients were followed for a minimum of two years after surgery. In group one, the final mean AOFAS midfoot scale score was 83.1. Two patients eventually underwent tarsometatarsal joint fusion. In group two, the final mean score was 78.5, and three patients eventually underwent fusion. According to the authors, there was a statistical significant difference between the AOFAS scores of group one and two.
Conclusion: The authors concluded that the results of this study show a better short and medial term outcome as depicted in AOFAS scores with dorsal plating versus trans-articular screw ORIF. From this study, I have concluded that it is reasonable that avoiding any damage to articular cartilage in a trauma setting would be beneficial to reduce long term pain and dysfunction. However, this article lacks information regarding how the statistical significance was achieved and information on how the groups were designed. Therefore, follow up studies are warranted to provide more reliable data.