SLR - December 2020 - Pooja Srivastava
Dorsal Bridge Plating Versus Transarticular Screw Fixation for LisFranc Injuries: A Systematic Review and Meta-Analysis
Reference: Boksh K, Sharma A, Grindlay D, Divall P, and Mangwani J. Dorsal Bridge Plating Versus Transarticular Screw Fixation for LisFranc Injuries: A Systematic Review and Meta-Analysis. J Clin Orthop Trauma. 2020;11(3):508-513.
Level of Evidence: Level 1
Scientific Literature Review
Reviewed By: Pooja Srivastava, DPM
Residency Program: McLaren Oakland Hospital – Pontiac, MI
Podiatric Relevance: Lisfranc injuries are commonly discussed in foot and ankle trauma. However, suboptimal or delayed treatment can lead to deleterious consequences including arthritis, chronic pain, residual instability, and soft tissue injuries. Transarticular screw fixation has been the traditional surgical technique in managing such injuries when open reduction and internal fixation (ORIF) is employed. However, this form of fixation may have complications that include articular disruption, metal breakage, and failure of fracture compression. Thus, the question of whether a more favorable fixation construct exists was explored. The authors of this study attempted to perform a systematic review and meta-analysis to investigate outcomes of transarticular screw fixation (S) versus dorsal bridge plating (P) for Lisfranc injuries.
Methods: A systematic review and meta-analysis were performed. Literature was acquired from database searches within Ovid MEDLINE, Ovid EMBASE, and Cochrane CENTRAL. Studies included all RCTs and cohorts comparing outcomes of transarticular screw and dorsal bridge plating for Lisfranc injuries. Patients under the age of 18 were excluded from the analysis. Outcome measures reviewed included post-operative infection rate, AOFAS functional score, foot function index (FFI) score, post-traumatic arthritis, and hardware failure.
Results: After a through extensive abstract review and study selection per PRISMA guidelines, the authors included four total studies for final analysis. In total, 210 subjects with acute Lisfranc injuries were studied: 93 underwent screw fixation and 117 underwent dorsal bridge plating. The outcome measures reviewed included post-operative infection (p = 0.92), post traumatic arthritis (p = 0.08), implant failure (p = 0.13), and FFI scores (p = 0.87) showed no statistical significance between the two groups. AOFAS scores were higher for the dorsal bridge plating group with statistical significance (p = 0.02).
Conclusions: The authors found that dorsal bridge plating is associated with higher AOFAS scores compared with transarticular screws for acute Lisfranc injuries. A trend towards lower rates of arthritis was noted in the dorsal bridge plating group even though it was not statistically significant. The authors concluded that the improvement in functional recovery from dorsal bridge plating in comparison to screw fixation is likely due to the preservation of the articular surface and minimizing arthrosis. With dorsal bridge plating, patients may begin earlier range of motion that may aid in limiting muscle atrophy and disuse osteopenia (factors that influence AOFAS scores). The authors note that dorsal bridge plating requires more extensive dissection and may increase the risk of postoperative infection even though the study found no statistical significance between the groups. With respect to ORIF, Lisfranc injuries have a plethora of fixation options with no single gold standard approach. The degree of injury, the age of the injury, and the patients’ needs, and habitus are factors that may dictate a surgeon’s choice of fixation for these injuries. After reading this article, one may consider using a dorsal bridge plate over transarticular screw for a patient who is younger, more active, and/or needs to return to activity sooner.