Open reduction internal fixation versus primary arthrodesis for lisfranc injuries: a prospective randomized study

Dislocations and fracture-dislocations involving the tarsometatarsal joint are a relatively common injury. These injuries are associated with long-term disability from subsequent painful osteoarthritis and residual deformity. This study evaluated whether performing a primary arthrodesis (PA) resulted in improved functional outcome and fewer subsequent surgeries as compared to primary open reduction and internal fixation (PORIF).

Forty patients with acute tarsometatarsal joint fractures or fracture dislocations were prospectively randomized to undergo either PORIF or PA. Clinical and radiographic examination, in addition to Short Form-36 (SF-36) and Short Musculoskeletal Function Assessment (SMFA) questionnaires, were evaluated at intervals of 3, 6, 12, and 24 months following surgery in 32 patients. A patient satisfaction phone survey was also performed.

The rate of planned and unplanned secondary surgeries, including hardware removal and salvage arthrodesis, between ORIF and PA groups, 78.6% vs. 16.7% was significantly different. No statistically significant differences were found with physical functioning for the PORIF or PA groups with regard to SF-36 or SMFA scores at any followup time interval. However, time from injury had a significant effect with impaired functioning at three months compared to all future intervals. No difference in satisfaction rates were found between PORIF and PA at an average of 53 months in a phone survey.

PA of tarsometatarsal joint injuries resulted in a significant reduction in the rate of followup surgical procedures if hardware removal is routinely performed with no significant difference in SF-36 and SMFA outcome scores when compared to PORIF.