SLR - February 2020 - Steven B. Georgian
Reference: Meulenkamp, B., Sharr, J., & Buckley, R. (2019). Ligamentous Lisfranc Injury: ORIF or Primary Arthrodesis? Injury, 50(12), 2155–2157. doi: 10.1016/j.injury.2019.11.024Scientific Literature Review
Reviewed By: Steven B. Georgian, DPM
Residency Program: West Penn Hospital – Pittsburgh, PA
Podiatric Relevance: Lisfranc injuries accounts for about 0.2 percent of all fractures and the reported incidence is approximately one per 55,000 persons per year. Despite this injury being relatively uncommon, it is important to have a high level of clinical suspicion given that as many as 20 percent of Lisfranc injuries are missed on initial examination. After diagnosing a patient with a Lisfranc’s injury, there is great debate as to how to proceed with treatment. This study examines the advantages and disadvantages of treating ligamentous Lisfranc injuries by means of open reduction internal fixation (ORIF) and primary arthrodesis (PA).
Methods: This is a review of treatment options that compares ORIF vs PA for treating Lisfranc injuries. The authors of this review have highlighted several key factors that need to be discussed with each patient in order to choose the correct treatment option for each patient. These factors include stiffness, available remaining motion at tarsometatarsal joints (TMT) after procedure, recovery time and hardware removal.
Results: After reviewing previous studies that looked at PA vs ORIF for the treatment of Lisfranc injuries, the authors of this study found that less post-operative immobilization was necessary in patients who underwent PA group vs ORIF group (six weeks vs 10-12 weeks). Medial column stiffness has been noted to be more after PA of Lisfranc’s joint than compared with ORIF of the joint; however medial column stiffness after primary fusion has not proven to affect patient return to sport. One of the main advantages that ORIF has over PA for treating Lisfranc injuries is the ability to preserve motion across the midfoot joints. This helps to alleviate pressure across the forefoot which decreases the chance of developing metatarsalgia, which is a common complication seen with medial column stiffness after PA. The author of this study recommends treating ORIF as a staged procedure, with the second stage being hardware removal. Leaving the hardware in place has the potential to create significant symptomatology.
Conclusions: The authors of this study have listed several advantages and disadvantages for treating ligamentous Lisfranc injuries by means of ORIF and PA after a review of the literature. The authors strongly advocated taking into consideration both the advantages and disadvantages of each procedure in order to fully assess each patient and determine the correct procedure needed.