Session X1I - Foot and Ankle


Sat., 10/22/05 Foot and Ankle, Paper #55, 3:18 pm

Treatment of Lisfranc Injuries: Primary Arthrodesis Compared with Open Reduction and Internal Fixation

Thuan V. Ly, MD (n); J. Chris Coetzee, MD (n);
University of Minnesota, Minneapolis, Minnesota, USA

Purpose: Open reduction and internal fixation (ORIF) is currently the accepted treatment for Lisfranc complex injuries. Despite anatomic reduction and stable internal fixation, these injuries do not have uniform excellent outcomes. The objective of this study is to compare primary arthrodesis to the traditional ORIF of Lisfranc complex injuries.

Methods: 41 patients with acute isolated or subacute missed Lisfranc complex injuries were followed over an average of 42.5 months (range, 25 to 60 months). These patients were enrolled in a prospective, randomized clinical trial comparing primary arthrodesis to traditional ORIF of ligamentous Lisfranc injuries. Evaluation was performed with clinical examination, radiography, AOFAS Midfoot Scale, visual analog scale, and a clinical questionnaire.

Results: 20 patients (ORIF group) were treated with open reduction and screw fixation. 21 patients (Arthrodesis group) were treated with primary arthrodesis of the medial two or three rays. Anatomic initial reduction was obtained in 18 of the 20 ORIF patients and 20 of the 21 arthrodesis patients. Average time to fusion for the arthrodesis group was 10.6 weeks. At final follow-up (mean 42 months) for the ORIF group, the AOFAS Midfoot score was 57.1 (range, 16 to 100). The mean follow-up for the arthrodesis was 43.4 months and the AOFAS Midfoot score was 86.9 (range, 63 to 100); P<0001. Five (25%) patients in the ORIF group had persistent pain or developed significant deformity or osteoarthrosis and required conversion to fusion. Only 6 (30%) of the ORIF group were back at their preinjury level of activity at 35 months, while 15 (71%) of the primary arthrodesis group had returned to their previous level of activity.

Conclusion/Significance: A stable arthrodesis is achievable as primary treatment for ligamentous Lisfranc injuries. Primary fusion appears to have a better medium- and long-term outcome than the traditional ORIF treatment of ligamentous Lisfranc injuries.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.