A systematic review and meta-analysis of the treatment of acute lisfranc injuries: Open reduction and internal fixation versus primary arthrodesis |
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| Affiliation: | 1. York Teaching Hospital NHS Foundation Trust, The York Hospital Wigginton Road, York, YO31 8HE, United Kingdom;2. Mid Cheshire Hospitals NHS Foundation Trust, Leighton Hospital, Crewe, Cheshire, CW1 4QJ, United Kingdom;1. Department of Trauma and Orthopaedics, Leicester Royal Infirmary, United Kingdom;2. Centre for Evidence Based Hand Surgery, University of Nottingham, United Kingdom;1. The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children, in Alliance with UCLA, 403 W. Adams Blvd., Los Angeles, CA 90007, United States;2. University of Southern California Department of Biomedical Engineering, Los Angeles, CA, United States;3. University of California, Los Angeles Department of Orthopaedic Surgery, Los Angeles, CA, United States;4. Los Angeles County Harbor—UCLA Medical Center, Los Angeles, CA, United States;1. Department of Orthopedic Surgery, Pontificia Universidad Catolica de Chile. Diagonal Paraguay 362, Postal code: 8330077, Santiago, Región Metropolitana, Chile;2. Department of Orthopaedics and Traumatology, Cantonal Hospital of Winterthur, Buchnerstrasse 1, 8006 Zurich, Switzerland;3. Department of Orthopaedics, Division of Distal Extremities, University of British Columbia, Vancouver, British Columbia, Canada;4. Department of Orthopedics, St. Paul''s Hospital, UBC, Vancouver, Canada;5. Footbridge Centre for Integrated Orthopaedic Care Inc., Footbridge Clinic, 221-181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada;1. Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea;2. Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Republic of Korea;1. Department of Orthopedic Surgery, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 333, Cerqueira Cesar, Sao Paulo, São Paulo 05403-010, Brazil;2. Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil;3. Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins drive, Iowa City, IA 52242, USA |
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| Abstract: | BackgroundInjuries to the Lisfranc complex, although relatively rare carry a high morbidity and are often associated with other injuries. Despite a number published studies to determine the best operative management, there is an ongoing debate to whether open reduction and internal fixation (ORIF) or primary arthrodesis (PA) produces the best outcomes for patients. There have been further studies published in the last few years that have not been assessed as part of the wider literature and therefore we wished to perform an updated systematic review and meta-analysis with inclusion of outcomes not assessed in the previous studies.MethodsWe performed a structured search for retrospective and prospective comparative papers and identified 8 relevant articles (2 RCT studies and 6 non-RCT studies) that compared the outcomes of ORIF versus PA; these studies included a total of 547 patients. Each of the studies was assessed for suitability and quality before inclusion. We performed a statistical analysis of the aggregated results as part of the review.ResultsWe found no statistically significant difference between the outcomes of ORIF versus PA in terms of return to work or activity (Odds Ratio 0.80 (CI 95%, 0.32–2.02, P = 0.64)) and satisfaction rates (Odds Ratio 0.15 (CI 95%, 0.01–.00, P = 0.25)). Patients undergoing ORIF have a higher risk of undergoing further surgery to remove the metalwork (Odds Ration 13.13 (CI 95%, 7.65–22.54, P < 0.00001)) or to undergo secondary fusion, but, the overall complication rates appear to be equivalent in both groups (risk difference 0.03 (CI 95%, –0.15–0.21, P = 0.76)).ConclusionsAlthough there were no significant differences in the functional outcomes, the overall power of the studies is low. The rates of metalwork removal and secondary fusion were higher in the ORIF group and this risk should be presented to the patient when counselling them for any procedure. We noted that there is a high level of heterogeneity in the type of injuries and measured outcomes included in each study and, therefore, further trials are needed to determine the best treatment across the spectrum of Lisfranc complex injuries. |
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| Keywords: | Lisfranc TMTJ Tarsometatarsal joint complex Foot Trauma Fracture Sports injuries Meta-analysis Review |
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