[Comparative study on effectiveness of two fixation methods in treatment of mid-column plantar-flexion Lisfranc...

To compare the effectiveness of open reduction with screw internal fixation versus primary arthrodesis for mid-column plantar-flexion Lisfranc injuries.

A retrospective analysis was performed on the clinical data of 45 patients (45 feet) with mid-column plantar-flexion Lisfranc injuries, who met the selective criteria between June 2019 and June 2022. Among them, 23 patients were treated with primary tarsometatarsal arthrodesis (arthrodesis group), and 22 patients received open reduction with screw internal fixation (screw group). There was no significant difference between groups ( P>0.05) in age, gender, body mass index, injured side, interval from injury to operation, Myerson classification, and preoperative visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, 36-Item Short-Form Health Survey (SF-36) score, the distance between the medial cuneiform and the second metatarsal (C1-M2), the distance between first and second metatarsal (M1-M2), step-off sign (SOS) displacement, and talus-first metatarsal angle (Meary angle). Operation time, incision length, intraoperative fluoroscopy frequency, intraoperative blood loss, time to initial weight-bearing, time to full weight-bearing, and postoperative complications during follow-up were recorded and compared. Pain and functional recovery were evaluated using VAS, AOFAS, and SF-36 scores. Radiographic parameters including C1-M2, M1-M2, SOS displacement, and Meary angle were measured during follow-up. Intergroup differences in the changes of the all outcome indicators from preoperative to last follow-up were also compared.

All patients underwent successful operation. The arthrodesis group had significantly longer operation time, longer incision length, more intraoperative fluoroscopy exposures, and greater intraoperative blood loss compared with the screw group ( P<0.05). All patients were followed up 24-36 months (mean, 27.6 months). No significant intergroup difference was found in time to initial weight-bearing or time to full weight-bearing ( P>0.05). At last follow-up, the indicators for function, pain, and imaging in both groups significantly improved compared with those before operation ( P<0.05). The arthrodesis group achieved significantly greater changes of AOFAS score, VAS score, SF-36 score, and Meary angle than the screw group ( P<0.05). No significant intergroup difference was found in the changes of C1-M2, M1-M2, and SOS ( P>0.05). The incidence of complication was significantly lower in arthrodesis group (8.6%, 2/23) than in screw group (36.3%, 8/22) ( P<0.05).

For mid-column plantar-flexion Lisfranc injuries, primary tarsometatarsal arthrodesis yields better functional recovery and pain relief compared with open reduction and screw internal fixation.