Primary fusion versus open reduction internal fixation for purely ligamentous lisfranc injuries: A Prospective comparative study and analysis of factors affecting the outcomes.

Autor: Kandil MI; Benha University, Faculty of Medicine, Egypt. Electronic address: dr_mahmoud_ibrahim@yahoo.com., Abouzeid M; Benha University, Faculty of Medicine, Egypt. Electronic address: abouziedmz83@gmail.com., Eltaher SM; Benha University, Faculty of Medicine, Egypt. Electronic address: sherif.abdelmonem@fmed.bu.edu.eg., Eltregy S; Benha University, Faculty of Medicine, Egypt. Electronic address: shareefaltraigy@fmed.bu.edu.eg.
Jazyk: angličtina
Zdroj: Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons [Foot Ankle Surg] 2022 Oct; Vol. 28 (7), pp. 898-905. Date of Electronic Publication: 2021 Dec 22.
DOI: 10.1016/j.fas.2021.12.006
Abstrakt: Background: The studies evaluating the outcomes of treatment of purely ligamentous unstable Lisfranc injuries are scarce. This study aimed at comparing outcomes of primary tarso-metatarsal joints fusion versus open reduction and internal fixation in treatment of such condition and determining the possible factors that may alter the outcomes.
Methods: This study comprised 30 patients; 16 in fusion group and 14 in ORIF group. One column was operated on in 2 patients, two columns in 21, and three columns in 7. The mean follow-up period was 36 months.
Results: There was no statistically significant difference between both groups regarding patients or injury characteristics. The mean AOFAS and FFI-Rs scores were 88.9 and 22.7 in the fusion group, compared to 61.7 and 34.5 in the ORIF group (P = .03,.04 respectively). At final follow-up all patients in the primary arthrodesis group were maintaining an anatomical reduction versus 71.5% in the ORIF group. Sixteen patients (53%) reported prominent hardware troubles that required removal. Five patients in ORIF group developed osteoarthritis, and four of them underwent secondary fusion. There was significantly higher incidence of posttraumatic osteoarthritis in patients with non-anatomical reduction and complete injuries. Better mean AOFAS and FFI-Rs scores occurred with non-smokers and with anatomical reduction.
Conclusion: Based on this limited case series, purely ligamentous Lisfranc injuries were found to have better outcomes when managed with a primary fusion as compared to ORIF. Achieving and maintaining anatomical reduction was the most important factor that is significantly attributed to improved outcomes. Possible arthritic changes and additional surgeries apart from implant removal could be avoided by primary fusion.
Level of Evidence: level I- prospective comparative case study.
(Copyright © 2021 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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