Comparison of Arthrodesis and Non‐fusion to Treat Lisfranc Injuries

Abstract

Objective “Lisfranc joint injury” is comprised of a tarsometatarsal joint‐complex injury. The Lisfranc complex injury is always a challenge for orthopedists, and the optimum treatment is still up for debate. Anatomic reduction and stable internal fixation prove to have no satisfactory outcomes. This research aims to compare the clinical curative effects, complications and radiographic features of arthrodesis and non‐fusion of the Lisfranc joint in the follow‐up of the patients who suffered Lisfranc injuries. Methods A comparative retrospective study of 25 patients with acute or subacute Lisfranc complex injuries was conducted between September 2013 and March 2015 in the First Affiliated Hospital of Soochow University. All patients were classified by Myerson classification. Eight patients were treated with arthrodesis, while 17 patients received non‐fusion operations. The clinical curative effects, complications and image differences were compared between the two groups. American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, Short Form‐36 (SF‐36) and Visual Analogue Scale (VAS) score were evaluated for each patient during the follow‐up. All statistics were analyzed using the SPSS software system. Results All fractures healed for both the arthrodesis group and the non‐fusion group. Patients in the arthrodesis group had a higher AOFAS score compared with patients in the non‐fusion group (94.00 vs. 88.58, P = 0.034). Complications occurred in eight patients (8/17, 47%) in the non‐arthrodesis group, including the second and third phalanx abduction (1), talipes cavus (2), eversion deformity of front foot (3), eversion deformity of calcaneus (1), as well as postoperative infection (1). Only two patients (2/8, 25%) in the arthrodesis group suffered complications. One was a limitation of motion of the front foot and pain during walking; the other was an eversion deformity of front foot. Conclusion Primary arthrodesis has advantages compared to primary open reduction and internal fixation (ORIF): reduced foot deformity rates, sustained biomechanical morphology of the feet, reduced complications, higher level of function recovery, shorter time of surgical procedures, fewer complications, higher AOFAS score and fewer frequency of complications. According to our research, primary arthrodesis may be a better choice for treating Lisfranc injury.

Reoperation Rate Differences Between Open Reduction Internal Fixation and Primary Arthrodesis of Lisfranc Injuries

“…Such an analysis arguably confounds a staged, planned intervention inherent to the treatment algorithm with a complication. 6,12,17,18,28,29 Our study specifically excludes planned removal of hardware in calculating this value and found no difference in the reoperation rate between ORIF and PA. Current deliberation regarding comparative outcome of Lisfranc injury following ORIF versus PA remains nuanced. In the setting of PA, some have expressed concern about overloading adjacent joints and increasing the risk of secondary arthritis.…”

Dynamic Lisfranc Joint Repair Concept: Surgical Technique for a Synthetic Neoligamentplasty

“…Fixation of the medial, lateral and intermediate cuneiforms with trans-articular screws provide a stable fixation, but it destroys part of the articular surface and there is a necessity of implant removal to try to reestablish the articular function (4)(5)(6)(7). Primary arthrodesis is an option reported in the literature to treat the tarsometatarsal injuries (2,8). Arthrodesis eliminate normal motion of theses joints and may overload the adjacent joint.…”

Lisfranc fracture-dislocations: current management

“…55–57 Table 4 summarises the comparative studies of ORIF versus primary arthrodesis in lesions of the Lisfranc joint. 16,19,20,58,60…”