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Midfoot Arthrodesis after Failed Lisfranc Open Reduction and Internal Fixation
Megan L Campbell1,2, Oliver C Sroka1, Tyler Thorne1
1University of Utah Department of Orthopaedic Surgery.
Objectives:
To determine the incidence and risk factors for secondary arthrodesis (SA) and compare patients who underwent primary arthrodesis (PA) versus SA following ORIF for Lisfranc injuries.
Methods:
Design : Retrospective cohort.
Setting:
Single tertiary level 1 trauma center.
Patient Selection Criteria:
Adult patients treated surgically for Lisfranc injuries AO/OTA 85.1A-C +/- 85.2.A-C, 85.3A-C; 87.1.1A-C-87.5.1A-C; 89B) between 2003-2023 were included.
Outcome Measures And Comparisons:
Patients who underwent index PA were compared to those who underwent index ORIF and subsequent SA. A composite primary outcome was used for comparison which included the development of adjacent midfoot arthrosis, midfoot collapse, or mal/nonunion rated satisfactory, suboptimal, poor, or severe; secondary outcomes were PROMIS measures of physical function (PF) and pain interference (PI). Descriptive and comparative statistics, multivariable analysis, and logistic regression were utilized to compare groups.
Results:
Of 489 Lisfranc injuries (482 patients), index treatment for 98 (20%) was PA. Average age was 37.7y (SD 15.6); mean follow up was 2.3y (SD 8.8). Fifty six percent of patients were men. There were thirty-four SAs (8.7% of index ORIF group). Patients who underwent SA were more likely to develop a poor (21.9% vs. 6.5% p=0.021) or severe outcome (12.5% vs. 1.1%, p=0.015) compared to those who underwent PA (OR 5.1, CI 1.4-18.5; OR 12.7, CI 1.1-12.8). Patients requiring SA also had significantly higher PI and significantly lower PF at final follow-up (p=0.018, p<0.001). Divergent injuries had higher odds of needing a SA compared to homolateral injuries (OR 6.9, p=0.006), as did index treatment with a tightrope (OR 4.6, p=0.003).
Conclusions:
Nine percent of patients underwent SA after index ORIF of their Lisfranc injury, and outcomes fared substantially worse than those treated with PA. This emphasizes the importance of identifying risk factors for patients that may fail ORIF. Further work is needed to clearly delineate which patients may best be served with PA.
Level Of Evidence:
Level 3.
