Clinical Outcomes after ORIF vs Arthrodesis for Subtle Lisfranc Injuries: A Minimum 2-Year Comparative Study

Area of Science:

• Orthopedic surgery
• Foot and ankle trauma
• Biomechanics

Background:

• Subtle Lisfranc injuries (2-5 mm diastasis) present unique treatment challenges.
• Distinguishing subtle injuries from severe ones is crucial for appropriate management.
• Current treatment strategies lack definitive comparative outcome data.

Purpose of the Study:

• To compare clinical outcomes and complication rates between primary open reduction internal fixation (ORIF) and primary arthrodesis (PA) for subtle Lisfranc injuries.
• To evaluate the effectiveness of ORIF versus PA in improving patient-reported physical function.
• To identify any significant differences in subsequent procedures or complications between the two treatment groups.

Main Methods:

• Retrospective comparative study of 73 patients with subtle Lisfranc injuries (2-5 mm diastasis).
• Patients underwent either primary ORIF (32) or primary arthrodesis (PA) (41).
• Preoperative radiographs confirmed injuries; patient-reported outcomes (PROMIS scores) were collected preoperatively and at minimum 2-year follow-up.

Main Results:

• Both ORIF and PA groups showed significant improvements in PROMIS physical scores at 2-year follow-up.
• No significant difference in overall patient-reported outcomes or complication incidence between ORIF and PA.
• The ORIF group had a significantly higher rate of hardware removal procedures compared to the PA group (P < .01).

Conclusions:

• Both ORIF and PA appear to be viable treatment options for subtle Lisfranc injuries, yielding comparable patient-reported outcomes.
• While complication rates were similar, ORIF necessitates more hardware removal surgeries.
• Further research is warranted to determine optimal treatment selection based on patient-specific factors and injury characteristics.