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Open reduction internal fixation versus primary arthrodesis for lisfranc injuries: a prospective randomized study
Jeffrey A Henning1, Clifford B Jones, Debra L Sietsema
1Michigan State University, College of Human Medicine, Department of Orthopaedic Surgery, Orthopaedic Associates of Michigan, Grand Rapids, MI 49503, USA.
Foot & Ankle International
|October 3, 2009
Summary
Primary arthrodesis (PA) for tarsometatarsal injuries significantly reduces follow-up surgeries compared to open reduction and internal fixation (PORIF). Functional outcomes and patient satisfaction were similar between both surgical approaches for fracture-dislocations.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
Background:
- Tarsometatarsal joint injuries, including dislocations and fracture-dislocations, are common and can lead to long-term disability, osteoarthritis, and deformity.
- Evaluating surgical techniques is crucial for optimizing patient outcomes in these complex injuries.
Purpose of the Study:
- To compare the efficacy of primary arthrodesis (PA) versus primary open reduction and internal fixation (PORIF) for acute tarsometatarsal joint injuries.
- To assess functional outcomes, subsequent surgical needs, and patient satisfaction between the two surgical methods.
Main Methods:
- Prospective randomized trial involving 40 patients with acute tarsometatarsal joint fractures or fracture-dislocations.
- Patients were randomized to either PORIF or PA. Clinical, radiographic, and patient-reported outcomes (SF-36, SMFA) were assessed at 3, 6, 12, and 24 months. A satisfaction survey was also conducted.
Main Results:
- A significantly lower rate of secondary surgeries (16.7%) was observed in the PA group compared to the PORIF group (78.6%).
- No significant differences in functional outcomes, as measured by SF-36 and SMFA scores, were found between the PORIF and PA groups at any follow-up interval.
- Patient satisfaction rates were comparable between the two groups at an average of 53 months post-surgery.
Conclusions:
- Primary arthrodesis (PA) leads to a significant decrease in the need for follow-up surgical procedures for tarsometatarsal joint injuries, particularly when hardware removal is standard.
- Both PA and PORIF demonstrate similar functional outcomes and patient satisfaction scores in the long term.
- The choice between PA and PORIF may depend on the goal of minimizing subsequent surgeries.