Patient Reported Outcomes for Primary Arthrodesis vs Open Reduction and Internal Fixation for Acute Lisfranc Injuries

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Both Primary Arthrodesis (PA) and Open Reduction and Internal Fixation (ORIF) have been shown to effectively treat Lisfranc injuries, however, debate remains regarding the complication rate for each procedure, and the data is limited regarding patient-reported outcomes. The purpose of this study is to evaluate the rate of acute complications, reoperations, patient-reported outcomes through the Patient Reported Outcome Instrumentation System (PROMIS), and postoperative radiographic data for PA versus ORIF for acute Lisfranc injuries. Methods: A retrospective review was conducted of patients who underwent PA or ORIF for the treatment of Lisfranc injuries at Prisma Health – Midlands between January 1st, 2020 - December 31st, 2022 with at least 6 months of postoperative data. Data collected included demographic data, postoperative outcomes, and Pain Interference (PI), Physical Function (PF) and Mobility PROMIS scores both preoperatively and at the most recent postoperative follow-up. Continuous variables were compared between PA and ORIF using the Student’s T-Test and Wilcoxon Rank Sum test for continuous variables and the Chi-Squared test for categorical variables. Results: A total of 56 patients were included in the study with an average follow-up time of 51.1 weeks (range: 27 to 121). Patients treated with ORIF were younger (30 vs 46.6, p=0.002) and were more likely to suffer a Myerson Classification type B1 injury (87.8% vs 28.6%, p=0.002) compared to those treated with PA. ORIF patients had greater improvements in PI (13.1 vs 9.7, p=0.508), PF (15.7 vs 7.2, p=0.343), and mobility (18.2 vs 10.3, p=0.203) compared to PA patients, although these improvements were not statistically significant. Finally, there was no significant difference in the rate of complications (p=1), reoperations (p=1), or evidence of radiographic hardware failure (p=0.423) between PA and ORIF. Conclusion: Patients treated with ORIF had greater improvements in patient-reported outcomes than those treated with PA, although these improvements were not statistically significant and there were potential confounding factors present. Both procedures demonstrated similar rates of complications, reoperations, and radiographic hardware failure. Our findings suggest that ORIF and PA are both effective in improving patient-reported outcomes and treating Lisfranc injuries in certain patient populations.