Background: The studies evaluating the outcomes of treatment of purely ligamentous unstable Lisfranc
injuries are scarce. This study aimed at comparing outcomes of primary tarso-metatarsal joints fusion
versus open reduction and internal fixation in treatment of such condition and determining the possible
factors that may alter the outcomes.
Methods: This study comprised 30 patients; 16 in fusion group and 14 in ORIF group. One column was
operated on in 2 patients, two columns in 21, and three columns in 7. The mean follow-up period was 36
months.
Results: There was no statistically significant difference between both groups regarding patients or injury
characteristics. The mean AOFAS and FFI-Rs scores were 88.9 and 22.7 in the fusion group, compared to 61.7
and 34.5 in the ORIF group (P = .03,.04 respectively). At final follow-up all patients in the primary arthrodesis group were maintaining an anatomical reduction versus 71.5% in the ORIF group. Sixteen patients
(53%) reported prominent hardware troubles that required removal. Five patients in ORIF group developed
osteoarthritis, and four of them underwent secondary fusion. There was significantly higher incidence of
posttraumatic osteoarthritis in patients with non-anatomical reduction and complete injuries. Better mean
AOFAS and FFI-Rs scores occurred with non-smokers and with anatomical reduction.
Conclusion: Based on this limited case series, purely ligamentous Lisfranc injuries were found to have better
outcomes when managed with a primary fusion as compared to ORIF.
Achieving and maintaining anatomical reduction was the most important factor that is significantly
attributed to improved outcomes. Possible arthritic changes and additional surgeries apart from implant
removal could be avoided by primary fusion.
Level of evidence: level I- prospective comparative case study |
