Open Reduction and Internal Fixation is Associated with Superior Wound Healing in the Treatment of Lisfranc Injuries Compared to Primary Arthrodesis

Research Type Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose Lisfranc injuries are a broad category of high-energy injuries to the midfoot. Optimal surgical management of Lisfranc injuries remains controversial, with open reduction internal fixation (ORIF) and primary arthrodesis (PA) representing two common reconstructive strategies. Prior studies have yielded mixed results regarding postoperative complications. This study evaluated 90-day and 2-year outcomes following Lisfranc repair via ORIF versus PA, excluding endpoints with 10 or fewer events. The goal of this study was to determine whether one technique confers a lower rate of composite adverse events and specific complications in Lisfranc injury repair. Methods We performed a retrospective analysis using the TriNetX research network, which aggregates deidentified electronic medical records from 104 healthcare organizations. We identified patients with tarsometatarsal dislocation injuries (ICD codes S93.324, S93.325, and S93,326) within 7 days of ORIF for tarsometarsal dislocation (n = 6,846 prematching, 2,252 postmatching) and tarsometatarsal PA (n = 2,259 prematching, 2,252 postmatching). Propensity score matching on age, sex, race, type II diabetes mellitus, and body mass index produced balanced cohorts. Primary endpoints included a composite any adverse event and individual complication rates including death, dehiscence, pulmonary embolism (PE), acute myocardial infarction (MI), cerebral infarction, transfusion, deep vein thrombosis (DVT), surgical site infection (SSI), sepsis, and emergency department (ED) visit. Endpoints with ≤10 events were excluded. Rates, odds ratios (ORs), and p values were calculated for both the 90-day and 2-year time windows. Results At 90 days, the composite adverse event rate was similar between ORIF (8.3%) and PA (8.8%, OR 0.94, 95% CI: 0.78–1.16, p = 0.558). However, dehiscence was significantly lower in ORIF compared to PA (3.6% vs. 5.5%, p = 0.003). Other complications including pulmonary embolism, acute myocardial infarction, cerebral infarction, transfusion, DVT, SSI, ED visits, hematoma, and sepsis showed no statistically significant differences at 90 days. At 2 years, composite adverse event rates remained comparable (12.9% vs 14.0%, p = 0.256), with dehiscence again significantly lower in the ORIF group (3.6% vs 5.5%, p = 0.003). Conclusion In this TriNetX study of Lisfranc injury reconstruction, ORIF and PA yielded similar composite adverse event rates at both 90 days and 2 years. Notably, ORIF was associated with a significantly lower incidence and frequency of wound dehiscence compared with PA. These findings suggest that while both techniques are generally safe, ORIF may offer an advantage in terms of wound healing. Further prospective studies are warranted to confirm these results and to assess the impact on long-term functional outcomes.