Primary Arthrodesis Versus Open Reduction and Internal Fixation Outcomes for Lisfranc Injuries: An Analysis of Conflicting Meta-analysis Results

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: The superiority of Primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in Lisfranc injuries has been debated for decades. In recent years, researchers have attempted to use meta-analyses to reach a definitive conclusion. However, they have reached uncertain and contradicting conclusions when comparing these treatment options, which has led to more confusion. The goal of this paper is to navigate the primary source data of each meta-analyses to determine why different conclusions were reached and provide surgeons with more clarity on the comparable outcomes of PA and ORIF treatment options in Lisfranc injuries. Methods: A systematic literature review was conducted by searching for ‘meta-analysis’ AND ‘Lisfranc’ with keywords such as ‘ORIF’ OR ‘open reduction’ OR ‘Arthrodesis’ OR ‘fusion’. Five meta-analysis articles discussing PA and ORIF in Lisfranc injuries were identified. Study outcomes were extracted from each article for comparison. Contradicting conclusions were identified, and the primary sources used by each meta-analysis was analyzed. Results: All meta-analyses agreed that PA had lower rates of hardware removal and that there is no significant difference between PA and ORIF when considering revision surgery, anatomic reduction, postoperative infection, total complications, and patient satisfaction. However, contradicting conclusions were reached regarding functional patient outcomes such as return to duty, the American Orthopaedic Foot & Ankle Society (AOFAS) score, and visual analogue scale (VAS) score. Conclusion: PA has favorable rates of hardware removal compared to ORIF, while no difference between PA and ORIF was found for revision surgery, anatomic reduction, postoperative infection, total complications, and patient satisfaction.While certain meta-analyses had contradicting conclusion as to which treatment option is favorable for returning to duty, AOFAS score, and VAS score, it was determined there was no significant difference in PA and ORIF for return to work and VAS score. Repeat meta- analysis with truly equivocal outcomes would be necessary to reach a valid conclusion for return to full activity and AOFAS midfoot scores.