Title: Treatment of Primarily Ligamentous Lisfranc Joint Injuries: Primary Arthrodesis Compared with Open Reduction and Internal Fixation
Authors: J. Chris Coetzee, MD, FRCSC, Thuan V. Ly, MD
Source: JBJS (American). 2007; 89-A: 122-127.
PODIATRIC RELEVANCE:
Lisfranc joint injuries are commonly treated with open reduction and internal fixation. The difficulty in treating such an injury is often complicated due to the instability of the joint. By performing open reduction, the surgeon is relying upon the quality of the scar tissue that is formed at the joint. The arthrodesis procedure may provide a better and more reliable correction.
METHODS:
In this article a prospective, randomized clinical trial compared primary arthrodesis with traditional open reduction and internal fixation. This study consisted of forty-one patients with an isolated acute or subacute primarily ligamentous Lisfranc joint injury. The patients were followed for an average of 42.5 months. The evaluation of these patients consisted of clinical examination, radiographs, the American Orthopedic Foot and Ankle Society (AOFAS) Midfoot Scale, visual analog scale, and a clinical questionnaire.
RESULTS:
Twenty patients were treated with open reduction and screw fixation, and twenty-one were treated with primary arthrodesis of the medial two or three rays. Two patients in the open reduction group and one in the arthrodesis group obtained anatomic initial reduction. Two years postoperatively, the mean AOFAS midfoot score was 68.6 and the open reduction group was 88 points (p < 0.005). Five patients in the open reduction group had persistent pain with the development of deformity or osteoarthritis (which was eventually treated with arthrodesis). Patients with a primary arthrodesis estimated that their postoperative level of activities was 92% of their injury level. The group treated with open reduction estimated that their postoperative level was only 65% of their preoperative level (p < 0.005).
COMMENTS:
This prospective, randomized clinical trial showed that by doing an arthrodesis for the medial rays, a patient may have a better outcome than open reduction. Open reduction is still a good form of treatment for such an injury, but this study demonstrates the great potential for further investigation.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.