Postoperative Complications of Percutaneous and Open Treatment of Lisfranc Injuries: A Matched Analysis

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Lisfranc injuries are complex midfoot disruptions that often require surgical intervention, with open reduction internal fixation (ORIF) and percutaneous skeletal fixation representing two common treatment strategies. Despite their widespread use, comparative data on perioperative and long-term complications remain limited. Using de-identified electronic health records from the TriNetX research network, we retrospectively compared 90-day and 2-year outcomes between patients undergoing Lisfranc ORIF and those treated with percutaneous fixation. The purpose of this study was to assess differences in the composite any adverse event rate and to evaluate specific complications with statistically significant differences between the groups at both time intervals. Methods: We conducted a retrospective analysis using the TriNetX platform to identify patients undergoing Lisfranc injury repair via ORIF (CPT 28615) or percutaneous skeletal fixation (CPT 28606) with tarsometatarsal dislocation injuries (ICD codes S93.324, S93.325, and S93,326) within 7 days of surgery. Initial cohorts included 6,846 ORIF and 1,113 percutaneous patients, which were propensity-matched for age, sex, race, type II diabetes mellitus, and body mass index to give 1,100 patients per cohort. Outcomes were assessed at 90 days and 2 years following the index procedure. A composite any adverse event endpoint and individual complications were analyzed using rates, odds ratios (ORs), and p values. Endpoints with 10 or fewer events in either group were excluded. Statistical significance was determined at p < 0.05. Results: At 90 days, the ORIF cohort demonstrated a significantly lower rate of any adverse event (7.8% vs 12.1%; p = 0.001) compared to the percutaneous group. Additionally, the ORIF cohort demonstrated significantly lower rates of transfusion (1.0% vs 2.1%; p = 0.038), surgical site infection [SSI] (2.1% vs 4.5%; p = 0.002), and emergency department (ED) visits (12.7% vs 25.5%; p < 0.001). At 2 years, the percutaneous group experienced significantly greater rates of any adverse event (11.4% vs 17.5%; p < 0.001), transfusion (p = 0.013), DVT (p = 0.03), SSI (p < 0.01), ED visits (p < 0.01), sepsis (p = 0.02), and venous thromboembolism (DVT and PE) (p = 0.03). Dehiscence, PE, acute MI, and cerebral infarction rates remained similar at 2 years. Conclusion: Compared with percutaneous fixation, Lisfranc ORIF was associated with significantly lower rates of composite adverse events and select complications, including transfusion, surgical site infection, and emergency department visits, at both 90 days and 2 years. These findings suggest that though an open approach has a theoretical increased complication risk being more invasive, ORIF of Lisfranc injuries may confer a more favorable short-term and long-term safety profile. Prospective studies are warranted to further refine surgical decision-making and optimize patient outcomes.