Abstract
Research Type
Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies
Introduction/Purpose
Injuries to the tarsometatarsal (TMT) joints are a relatively rare foot injury, and are often seen surrounding motor vehicle accidents, falls from height, or low-energy twisting of the foot. If not adequately managed, Lisfranc injuries of the TMT complex are associated with chronic pain and progressive collapse of the medial foot. Previous studies have shown good, comparable clinical outcomes when Lisfranc injuries are managed with open reduction internal fixation (ORIF) and primary arthrodesis (PA). However, there is no data on any results for primarily medically underserved patients. This study aimed to assess Lisfranc injury management and complications in an entire cohort of empanelled Medicaid patients at a county Level I Trauma center.
Methods
106 patients who sustained acute injuries to the TMT Lisfranc complex were included in the study. All patients had state Medicaid as primary insurance and empanelled to a major county facility. 91 patients underwent acute ORIF of the Lisfranc injury, while 15 underwent PA of the involved midfoot joints. Surgeon fellowship status, and patient demographic data, comorbidities, and postoperative data including emergency room visits, superficial/deep infections, secondary procedures for revision or hardware removal, and pain data throughout recovery were collected. Fisher’s exact tests were conducted for complications data, and Cox proportional hazards model was utilized to depict the postoperative pain data. Primary outcome measure was unplanned reoperation rate. Secondary outcomes included early complication rate, time to pain improvement postoperatively, and differences in these metrics for Foot and Ankle versus Trauma fellowship trained surgeons.
Results
There was a greater rate of unplanned reoperation in the PA group (13% vs 1.1%) but did not reach statistical significance. Patients had a median follow-up of 189 days, ranging from 11 to 1093 days. There were no significant differences in early ( < 90 days) or late (>90 days) complication rates, and no differences in emergency room utilization. There was also no difference in the likelihood of reaching a pain score < 3 postoperatively, and nearly identical time to reach minimal pain of less than or equal to three out of ten, 28.5 days for ORIF and 29 days for PA. There were no significant differences in any of these metrics when accounting for fellowship training of the orthopaedic surgeon, Foot and Ankle versus Trauma.
Conclusion
ORIF and PA of Lisfranc injuries both resulted in statistically similar complication profiles, reoperation rates, and pain resolution in our cohort. Both ORIF and PA are excellent options when indicated for low-income, Medicaid-eligible trauma patients.
