Temporary Bridge Plating vs Primary Arthrodesis of the First Tarsometatarsal Joint in Lisfranc Injuries: Randomized Controlled Trial.

Are H Stødle,Elisabeth Ellingsen Husebye,Jan Erik Madsen,Kjetil H Hvaal,Helga M Brøgger

doi:10.1177/1071100720925815

Are H Stødle, Elisabeth Ellingsen Husebye + Show 3 more

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https://doi.org/10.1177/1071100720925815

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Abstract

Background:Unstable Lisfranc injuries are best treated with anatomic reduction and stable fixation. There are controversies regarding which type of stabilization is best. In the present study, we compared primary arthrodesis of the first tarsometatarsal (TMT) joint to temporary bridge plating in unstable Lisfranc injuries.Methods:Forty-eight patients with Lisfranc injuries were included and followed for 2 years. Twenty-four patients were randomized to primary arthrodesis (PA) of the medial 3 TMT joints, whereas 24 patients were randomized to temporary bridge plate (BP) over the first TMT joint and primary arthrodesis of the second and third TMT joints. The main outcome parameter was the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scale and the secondary outcome parameters were the 36-Item Short Form Health Survey (SF-36) and visual analog scale for pain (VAS pain). Computed tomography (CT) scans pre- and postoperatively were obtained. Radiographs were obtained at follow-ups. Pedobarographic examination was performed at the 2-year follow-up. Twenty-two of 24 patients in the PA and 23/24 in the BP group completed the 2-year follow-up.Results:The mean AOFAS midfoot score 2 years postoperatively was 89 (SD 9) in the PA group and 85 (SD 15) in the BP group (P = .32). There were no significant differences between the groups with regard to SF-36 or VAS pain scores. The alignment of the first metatarsal was better in the BP group than in the PA group measured by the anteroposterior Meary angle (P = .04). The PA group had a reduced peak pressure under the fifth metatarsal (P = .047). In the BP group, 11/24 patients had radiologic signs of osteoarthritis in the first TMT joint.Conclusion:Both treatment groups had good outcome scores. The first metatarsal was better aligned in the BP group; however, there was a high incidence of radiographic osteoarthritis in this group.Level of Evidence:Therapeutic level I, prospective randomized controlled study.

Highlights

In addition to the planned removal of the bridge plate in the BP group, 7/23 patients in the PA and 5/24 patients in the BP group had hardware removed (P = .450) at a median of 302 days (IQR, 149-725). In this randomized controlled trial comparing temporary bridge plating (BP) to primary arthrodesis (PA) of the first TMT joint in acute Lisfranc injuries, we were not able to detect superiority of the BP group compared to the PA group using American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score, visual analog scale (VAS) pain score, or SF-36 at 2-year follow-up
The first metatarsal was better aligned in the AP radiographs in the BP group evaluated by the AP Meary angle
We did not find superiority of the BP group compared to the PA group according to the AOFAS midfoot score

Summary

Introduction

Lisfranc injuries are defined as injuries to the tarsometatarsal joint complex, which includes the tarsometatarsal (TMT) joints, intercuneiform and naviculocuneiform joints.[16,21] These injuries consist of a wide spectrum of injuries from nondisplaced, stable injuries to severe fracture dislocations.[6,21,24,31,32,35] Several studies have shown anatomic reduction and stable fixation to be the most important factors in achieving a good functional outcome in acute Lisfranc fracture dislocations.[2,5,14,17,23,28,36] The best technique used to achieve an anatomic and stable fixation of the joints is still debated. We compared primary arthrodesis of the first tarsometatarsal (TMT) joint to temporary bridge plating in unstable Lisfranc injuries. Methods: Forty-eight patients with Lisfranc injuries were included and followed for 2 years. Twenty-two of 24 patients in the PA and 23/24 in the BP group completed the 2-year follow-up. Results: The mean AOFAS midfoot score 2 years postoperatively was 89 (SD 9) in the PA group and 85 (SD 15) in the BP group (P = .32). The first metatarsal was better aligned in the BP group; there was a high incidence of radiographic osteoarthritis in this group. Level of Evidence: Therapeutic level I, prospective randomized controlled study

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