A Randomized Controlled Trial of Primary Arthrodesis Versus Temporary Bridge Plating in Unstable Lisfranc Injuries

The long-term consequences of preserving versus fusing the first tarsometatarsal joint (TMT 1) in unstable Lisfranc injuries remain unclear. We previously reported 2-year outcomes of a randomized controlled trial comparing primary arthrodesis (PA) with temporary dorsal bridge plating (BP) of TMT 1; all patients underwent PA of TMT 2 and 3. Forty-one (85%) of 48 patients (16 men and 25 women with a mean age of 33.4 years at the time of injury) completed clinical and computed tomography-based follow-up at a mean of 10.8 years. Outcomes included the AOFAS (American Orthopaedic Foot and Ankle Society) midfoot score, MOxFQ (Manchester-Oxford Foot Questionnaire), VAS (visual analogue scale) for pain, SF-36 (Short Form-36), presence of osteoarthritis (OA), and complications. At 10 years, no significant differences between the PA and BP groups were observed in AOFAS scores (89.3 versus 92.6; p = 0.66), MOxFQ, VAS pain, SF-36, return to activity, or orthotic use. Adjacent-joint OA rates were comparable. TMT 1 OA was frequent after BP, and 1 patient required secondary arthrodesis. Thus, both PA and BP yielded comparable long-term clinical and radiographic outcomes, but BP requires routine hardware removal, an additional procedure not required after PA. Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.