Objectives: To determine whether primary arthrodesis (PA) or open reduction and internal fixation (ORIF) results in better functional outcomes through patient-reported outcome measures (PROMs). Reoperation rates and surgical characteristics among the 2 groups are evaluated as well. Design: A retrospective cohort study. Setting: Level 1 trauma center. Patients: Eighty-one patients treated using PA or ORIF for Lisfranc injuries between January 2010 and January 2019. Main Outcome Measurements: PROMs were collected using the validated Foot and Ankle Ability Measure questionnaire. Follow-up ranged from 1 to 10 years posttreatment. Results: Two hundred patients underwent ORIF, and 72 patients underwent PA. Eighty-one of 272 patients responded to the questionnaire. The Foot and Ankle Ability Measure revealed activities of daily living subscores for PA and ORIF of 69.78 ± 18.61 and 73.53 ± 25.60, respectively (P = 0.48). The Sports subscores for PA (45.81 ± 24.65) and ORIF (56.54 ± 31.13) were not significantly different (P = 0.11). Perceived levels of activities of daily living (P = 0.32) and Sports (P = 0.81) function, compared with preinjury levels, were also not significantly different between the 2 groups. Rates of reoperation were nearly identical for PA (28.1%) and ORIF (30.6%) (P = 1.00). Conclusion: Our results suggest that neither PA nor ORIF is superior regarding functional outcomes or rates of reoperation in the surgical treatment of Lisfranc injuries when appropriately triaged by the treating surgeon. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Case Avascular necrosis (AVN) of the talus in a 45-year-old female following subchondroplasty with calcium phosphate bone filler for treatment of anterolateral and posteromedial talar dome bone marrow lesions (BMLs). The patient subsequently presented as consultation, 18 months postoperatively, with AVN of the talus. After failing conservative management, the patient underwent a total ankle arthroplasty at 46 months after subchondroplasty with resolution of pain. Conclusion There are few studies that have reported on the safety of subchondroplasty of the talus. Given the tenuous blood supply to the talar body and poor patient outcomes associated with AVN, caution should be taken before extrapolating the generally positive results of subchondroplasty in the knee. Level of Evidence: Level IV

Tissue transglutaminase (tTg) is postulated to play a role in apoptosis and/or differentiation in cultured cells. All trans‐retinoic acid (RA) is a naturally occurring molecule that binds to retinoic acid receptors responsible for apoptosis and differentiation. RA induces tTg activity in human erythroleukemia (HEL) cells, but in general, results in high toxicity. Heteroarotinoids (Hets) are less toxic synthetic structural analogues of RA and are defined as systems with one aromatic ring and one heteroatom (N, S, or O). We propose that Hets have a role in differentiation and/or apoptosis of HEL cells. To test this, HEL cells were cultured for 48 h with RA (tTg induction), DMSO (negative control) and Hets 1, 2, and 4 (experimental compounds). Hets 1, 2 and 4 showed significant growth inhibitions, lowered cell viability and induced apoptosis relative to DMSO and RA. tTg was quantitated in HEL cells using an inhibition ELISA assay. When an anti‐tTg monoclonal antibody was added to a sample containing tTg, an antigen‐antibody complex was formed. When this sample was added to a 96‐well microtiter plate containing attached tTg, less color was produced relative to an antibody sample that was not premixed with tTg. Preliminary results in Het 2 and Het 4‐treated cells showed elevated levels of tTg. The results appear promising for our hypothesis of a role for Hets in differentiation and/or apoptosis of HEL cells.