Sage Journals: Discover world-class research

Abstract

Background:

Controversy persists as to whether Lisfranc injuries are best treated with open reduction internal fixation (ORIF) versus primary arthrodesis (PA). Reoperation rates certainly influence this debate, but prior studies are often confounded by inclusion of hardware removal as a complication rather than as a planned, staged procedure inherent to ORIF. The primary aim of this study was to evaluate whether reoperation rates, excluding planned hardware removal, differ between ORIF and PA. A secondary aim was to evaluate patient risk factors associated with reoperation after operative treatment of Lisfranc injuries.

Methods:

Between July 1991 and July 2016, adult patients who sustained closed, isolated Lisfranc injuries with or without fractures and who underwent ORIF or PA with a minimum follow-up of 12 months were analyzed. Reoperation rates for reasons other than planned hardware removal were examined, as were patient risk factors predictive of reoperation. Two hundred seventeen patients met enrollment criteria (mean follow-up, 62.5 ± 43.1 months; range, 12-184), of which 163 (75.1%) underwent ORIF and 54 (24.9%) underwent PA.

Results:

Overall and including planned procedures, patients treated with ORIF had a significantly higher rate of return to the operation room (75.5%) as compared to those in the PA group (31.5%, P < .001). When excluding planned hardware removal, however, there was no difference in reoperation rates between the 2 groups (29.5% in the ORIF group and 29.6% in the PA group, P = 1). Risk factors correlating with unplanned return to the operation room included deep infection (P = .009-.001), delayed wound healing (P = .008), and high-energy trauma (P = .01).

Conclusion:

When excluding planned removal of hardware, patients with Lisfranc injuries treated with ORIF did not demonstrate a higher rate of reoperation compared with those undergoing PA.

Level of Evidence:

Level III, retrospective comparative study

Keywords

Lisfranc tarsometatarsal fusion ORIF arthrodesis

Get full access to this article

View all access options for this article.

References

Arntz

Veith

Hansen

Jr.

Fractures and fracture-dislocations of the tarsometatarsal joint. J Bone Joint Surg Am. 1988;70(2):173-181.

Aronow

MS.

Treatment of the missed Lisfranc injury. Foot Ankle Clin. 2006;11(1):127-142, ix.

Cassebaum

WH.

Lisfranc fracture-dislocations. Clin Orthop Relat Res. 1963;30:116-129.

Chiodo

Myerson

MS.

Developments and advances in the diagnosis and treatment of injuries to the tarsometatarsal joint. Orthop Clin North Am. 2001;32(1):11-20.

Clare

MP.

Lisfranc injuries. Curr Rev Musculoskelet Med. 2017;10(1):81-85.

Cochran

Renninger

Tompane

et al . Primary arthrodesis versus open reduction and internal fixation for low-energy Lisfranc injuries in a young athletic population. Foot Ankle Int. 2017;38(9):957-963.

Crates

Barber

Sanders

EJ.

Subtle Lisfranc subluxation: results of operative and nonoperative treatment. J Foot Ankle Surg. 2015;54(3):350-355.

Dubois-Ferriere

Lubbeke

Chowdhary

et al . Clinical outcomes and development of symptomatic osteoarthritis 2 to 24 years after surgical treatment of tarsometatarsal joint complex injuries. J Bone Joint Surg Am. 2016;98(9):713-720.

Eleftheriou

Rosenfeld

PF.

Lisfranc injury in the athlete: evidence supporting management from sprain to fracture dislocation. Foot Ankle Clin. 2013;18(2):219-236.

10.

Goossens

De Stoop

Lisfranc’s fracture-dislocations: etiology, radiology, and results of treatment. A review of 20 cases. Clin Orthop Relat Res. 1983;176:154-162.

11.

Hardcastle

Reschauer

Kutscha-Lissberg

et al . Injuries to the tarsometatarsal joint. Incidence, classification and treatment. J Bone Joint Surg Br. 1982;64(3):349-356.

12.

Henning

Jones

Sietsema

et al . Open reduction internal fixation versus primary arthrodesis for Lisfranc injuries: a prospective randomized study. Foot Ankle Int. 2009;30(10):913-922.

13.

Jain

Drampalos

Clough

TM.

Results of suture button fixation with targeting device aid for displaced ligamentous Lisfranc injuries in the elite athlete. Foot (Edinb). 2017;30:43-46.

14.

Komenda

Myerson

Biddinger

KR.

Results of arthrodesis of the tarsometatarsal joints after traumatic injury. J Bone Joint Surg Am. 1996;78(11):1665-1676.

15.

Krause

Schmid

Weber

Current Swiss techniques in management of Lisfranc injuries of the foot. Foot Ankle Clin. 2016;21(2):335-350.

16.

Kuo

Tejwani

Digiovanni

et al . Outcome after open reduction and internal fixation of Lisfranc joint injuries. J Bone Joint Surg Am. 2000;82 (11):1609-1618.

17.

Coetzee

JC.

Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study. J Bone Joint Surg Am. 2006;88(3):514-520.

18.

MacMahon

Kim

Levine

et al . Return to sports and physical activities after primary partial arthrodesis for Lisfranc injuries in young patients. Foot Ankle Int. 2016;37(4):355-362.

19.

Mantas

Burks

RT.

Lisfranc injuries in the athlete. Clin Sports Med. 1994;13(4):719-730.

20.

McHale

Vopat

Beaulieu-Jones

et al . Epidemiology and outcomes of Lisfranc injuries identified at the National Football League scouting combine. Am J Sports Med. 2017;45(8):1901-1908.

21.

Mulier

Reynders

Dereymaeker

et al . Severe Lisfrancs injuries: primary arthrodesis or ORIF? Foot Ankle Int. 2002;23(10):902-905.

22.

Mulier

Reynders

Sioen

et al . The treatment of Lisfranc injuries. Acta Orthop Belg. 1997;63(2):82-90.

23.

Myerson

Fisher

Burgess

et al . Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle. 1986;6(5):225-242.

24.

Nunley

Vertullo

CJ.

Classification, investigation, and management of midfoot sprains: Lisfranc injuries in the athlete. Am J Sports Med. 2002;30(6):871-878.

25.

Panchbhavi

Vallurupalli

Yang

et al . Screw fixation compared with suture-button fixation of isolated Lisfranc ligament injuries. J Bone Joint Surg Am. 2009;91(5):1143-1148.

26.

Perugia

Basile

Battaglia

et al . Fracture dislocations of Lisfranc’s joint treated with closed reduction and percutaneous fixation. Int Orthop. 2003;27(1):30-35.

27.

Puna

Tomlinson

MP.

The role of percutaneous reduction and fixation of Lisfranc injuries. Foot Ankle Clin. 2017;22(1):15-34.

28.

Qiao

Shen

et al . Comparison of arthrodesis and non-fusion to treat Lisfranc injuries. Orthop Surg. 2017;9(1):62-68.

29.

Reinhardt

Schottel

et al . Treatment of Lisfranc fracture-dislocations with primary partial arthrodesis. Foot Ankle Int. 2012;33(1):50-56.

30.

Richter

Wippermann

Krettek

et al . Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results. Foot Ankle Int. 2001;22(5):392-398.

31.

Seybold

Coetzee

JC.

Lisfranc injuries: when to observe, fix, or fuse. Clin Sports Med. 2015;34(4):705-723.

32.

Sheibani-Rad

Coetzee

Giveans

et al . Arthrodesis versus ORIF for Lisfranc fractures. Orthopedics. 2012;35(6):e868-e873.

33.

Smith

Stone

Furey

Does open reduction and internal fixation versus primary arthrodesis improve patient outcomes for Lisfranc trauma? A systematic review and meta-analysis. Clin Orthop Relat Res. 2016;474(6):1445-1452.

34.

Stavlas

Roberts

Xypnitos

et al . The role of reduction and internal fixation of Lisfranc fracture-dislocations: a systematic review of the literature. Int Orthop. 2010;34(8):1083-1091.

35.

Trevino

Kodros

Controversies in tarsometatarsal injuries. Orthop Clin North Am. 1995;26(2):229-238.

36.

Vuori

Aro

HT.

Lisfranc joint injuries: trauma mechanisms and associated injuries. J Trauma. 1993;35(1):40-45.

37.

Weatherford

Bohay

Anderson

JG.

Open reduction and internal fixation versus primary arthrodesis for Lisfranc injuries. Foot Ankle Clin. 2017;22(1):1-14.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.71 MB

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

Abstract

Background:

Methods:

Results:

Conclusion:

Level of Evidence:

Keywords

Get full access to this article

References

Supplementary Material