Primary Arthrodesis Compared with Open Reduction and Internal Fixation for Lisfranc Injuries with the First Tarsometatarsal Joint Dislocation: A Randomized Controlled Trial

Abstract

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Prospective analyses of treatment for the first tarsometatarsal joint dislocation with Lisfranc injury. Comparison of open reduction internal fixation (ORIF) and primary arthrodesis was conducted for the injury. Methods: 78 Lisfranc injuries with first tarsometatarsal joint dislocation underwent surgical intervention. They were 46 males and 32 females with mean age of 41.2 years. Two groups were randomized by ORIF group and primary arthrodesis group. 43 patients were performed by ORIF, while primary arthrodesis group including 35 cases. Outcome measures included radiographs, AOFAS scores, VAS and SF-36 scores. Complications and revision rate were analyzed also. Results: 73 patients were followed up for 21 months. At 1.5 years postoperatively, the AOFAS score was 75 and 83 in ORIF group and arthrodesis group. The VAS score was 3.0 and 2.1 separately in two groups. The mean Physical Functioning sores of SF- 36 was 81.2 points and 84.1 points. The Bodily Pain score of SF-36 was 79.3 points and 85.2 points. Redislocation of first tarsometarsal joint were observed in 11 cases among ORIF group.31 patients in ORIF group had pain in midfoot, six of them had persistent pain with the development of deformity or osteoarthrosis. No redislocation and no hardware failure was identified in arthrodesis group. Conclusion: Primary stable arthrodesis of the first ray gives a better short and medium term outcome than open reduction and internal fixation for Lisfranc injury with the first ray dislocation. Possible complication and revision could be avoided by primary arthrodesis for dislocated first ray injuries.