Open reduction and internal fixation compared with primary arthrodesis of Lisfranc injuries

Background Lisfranc fracture dislocations occur in approximately 0.1-0.9% of all fractures and are associated with long-term complications, including osteoarthritis and painful deformity. Our aim was to evaluate the best available evidence to assist in guiding clinical decision-making for open reduction and internal fixation compared with primary arthrodesis for acute Lisfranc injuries. Methods We systematically reviewed the effect of alternative methods of management of Lisfranc fractures on validated functional outcome scores and secondary outcomes of further surgery and pain. We identified 147 citations: 12 from MEDLINE, 135 from EMBASE and none from the Cochrane Central Register of Controlled Trials. Only three studies proved eligible. The authors graded and extracted the relevant data. Results All studies compared the treatment of acute Lisfranc fractures by primary arthrodesis with open reduction and internal fixation. All three studies were comparative studies of the two treatment modalities. Two studies were randomized. The relative merits of open reduction and internal fixation compared with primary arthrodesis in the treatment of Lisfranc injuries remains uncertain. The current evidence is mixed. One study reviewed patients with primarily ligamentous injuries and suggested that primary fusion of Lisfranc fractures does improve the functional outcome, whereas the most recent study, assessing osseous and ligamentous injuries, did not show this effect. Both studies, however, did show that secondary surgery was higher in the open reduction and internal fixation groups. Conclusions Given the current level of evidence, further studies, preferably randomized controlled prospective trials, are required to fully ascertain the most favorable management method for these complex and debilitating injuries.