Effect comparison between open reduction internal fixation and primary arthrodesis for treatment of Lisfranc injuries combined with first tarsal joint dislocation

Abstract

Objective To compare the effect and prognosis outcome of open reduction internal fixation and primary arthrodesis in treatment of Lisfranc injuries combined with the first tarsal joint dislocation. Methods A retrospective case control study was conducted on the clinical data with complete follow up data of 126 patients with Lisfranc injuries combined with the first tarsal joint dislocation in nine ankle surgery centers of China from January 2009 to June 2015. There were 76 males (60.3%) and 50 females (39.7%) with an average age of 45.5 years (range, 20-87 years). Among the 126 cases, simple dislocation occurred in 41 cases(32.5%), and fracture dislocation in 85 cases (67.5%). The duration from injury to surgery was 11.7 days (range, 4-26 days). According to surgery method, the patients were divided into open reduction internal fixation group (n=92) and primary arthrodesis group (n=34). The outcomes were evaluated by American Orthopedic Foot and Ankle Society(AOFAS) score, 36-items short form health survey (SF-36), and visual analogue score (VAS). Complications were also followed up. Results All patients were followed up for 18-80 months, with an average of 29.5 months. Primary union was seen in all the patients. At the last follow up, the mean AOFAS midfoot score was (79.4±6.7)points in open reduction and internal fixation group and (85.1±8.3)points in primary arthrodesis group(P 0.05). The body pain score of SF-36 was (76.1±4.6)points in open reduction and internal fixation group and (84.6±8.7)points in primary arthrodesis group (P<0.05). In open reduction and internal fixation group, there were five cases (5%) with internal fixator loosening or fracture, 16 cases (17%) with redislocation, 36 cases (39%) with obvious pain of the middle foot during walking, and eight cases (6%) with tarsal joint traumatic arthritis which was given phase II arthrodesis. In primary arthrodesis group, two patients (6%) reported pain due to internal fixation, and the pain was relieved after fixator removal. No re-dislocation, loosening of internal fixation, or traumatic arthritis were found (P<0.05). Conclusion For Lisfranc injuries combined with first tarsal joint dislocation, primary arthrodesis can stabilize the first tarsal joint and avoid complications or adverse consequences such as redislocation, pain, internal fixation failure, or reoperation. Key words: Foot injuries; Fracture fixation, internal; Arthrodesis