Comparison of primary arthrodesis versus open reduction with internal fixation for Lisfranc injuries: Systematic review and meta-analysis

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Date: April-June 2019
From: Journal of Postgraduate Medicine(Vol. 65, Issue 2)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 3,492 words
Lexile Measure: 1660L

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Byline: P. Han, Z. Zhang, C. Chen, Y. Han, X. Wei, P. Li

Objective: Multiple studies have compared primary arthrodesis versus open reduction with internal fixation (ORIF) for surgical treatment of fractures of the Lisfranc joint, but their results have been inconsistent. Therefore, the present systematic review and meta-analysis was performed to compare the clinical efficacy of arthrodesis versus ORIF for the treatment of Lisfranc injuries. Methods: Through searching the Embase, PubMed, PMC, CINAHL, PQDT, and Cochrane Library databases (from July 1998 to July 2018), we identified five case-controlled trials and two randomized controlled trials that compared the clinical efficacy of primary arthrodesis and ORIF for treating Lisfranc injuries. The extracted data were analyzed using Review manager 5.3 software. Results: Through comparisons of data for primary arthrodesis and ORIF groups, we found no significant differences in the anatomic reduction rate, revision surgery rate, and total rate of complications between the different treatment approaches. However, arthrodesis was associated with a significantly better American Orthopedic Foot and Ankle Society (AOFAS) score, return to duty rate, and visual analog scale score with a lower incidence of hardware removal compared with ORIF. Conclusions: For the treatment for Lisfranc injuries, primary arthrodesis was superior to ORIF based on a higher AOFAS score, better return to duty rate, lower postoperative pain, and lower requirement for internal fixation removal. Further evidence from future randomized controlled trials with higher quality and larger sample sizes is needed to confirm these findings.

Introduction

The Lisfranc joint, also known as the tarsometatarsal joint, connects the forefoot and midfoot and consists of three cuneiform bones, one cuboid bone, and five metatarsal bone.[1] This joint was originally named by the surgeon Jacques Lisfranc (1790-1847) in 1815.[2] Fractures of the Lisfranc joint are uncommon, accounting for only ~0.2% of all fractures in the body.[3] Notably, the incidence of fractures of the Lisfranc joint is two to four times higher in males than in the females though, and the reason may be the more frequent participation in high-impact exercise among males.[4] Fracture of the Lisfranc joint can occur at any age but is most frequently seen in young people in their 30s. Early diagnosis and treatment of the fracture are essential to restore and preserve function of the foot. Without proper treatment, the tarsometatarsal joint may cause arthritis or fracture nonunion may occur due to poor resetting and disorder, often leading to collapse of the second metatarsal arch structure.[5] The latter condition causes severe pain, osteoarthritis of the middle foot, and progressive loss of function, all of which negatively affect the patient's quality of life. At present, the most common treatments for fractures involving the Lisfranc joint are primary arthrodesis and open reduction with internal fixation (ORIF).[6],[7],[8] However, the optimal choice of surgical treatment remains controversial. Therefore, the present meta-analysis was performed to systematically compare the outcomes achieved with the two methods for the purpose of providing theoretical guidance for clinical practice.

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Online databases, including Embase, PubMed, PubMed Central, CINAHL,...

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Gale Document Number: GALE|A584164901