Hardware Removal After Lisfranc Open Reduction and Internal Fixation Results in Improved Physical Function

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Patient-reported outcomes

Background:

• Lisfranc injuries often require open reduction and internal fixation (ORIF).
• The decision for hardware removal (HWR) after ORIF for Lisfranc injuries is debated.
• PROMIS (Patient-Reported Outcomes Measurement Information System) scores assess physical function (PF) and pain intensity (PI).

Purpose of the Study:

• To evaluate the impact of HWR on PROMIS PF and PI scores following Lisfranc ORIF.
• To compare outcomes between patients who underwent HWR and those with retained hardware.

Main Methods:

• Retrospective cohort study at a Level-1 trauma center.
• Included adult patients with isolated Lisfranc injuries treated with ORIF (2002-2023).
• Analyzed PROMIS PF and PI scores at 6 months and 1 year post-surgery, comparing HWR vs. no HWR groups.

Main Results:

• 77 feet underwent HWR, and 30 had ORIF without HWR.
• HWR patients showed a significant increase in PF scores at 6 weeks post-removal (P < 0.001).
• Compared to retained hardware, HWR resulted in significant net improvements in both PF (5.6 points) and PI (1.7 points) scores (P = 0.002, 0.008).

Conclusions:

• HWR after Lisfranc ORIF leads to significant improvements in PROMIS physical function scores.
• Patients undergoing HWR demonstrate superior PROMIS physical function and pain intensity scores compared to those with retained hardware.