Primary Arthrodesis Versus Open Reduction and Internal Fixation for Lisfranc Injuries: Do Clinical Outcomes Differ?

Background/Objectives: Lisfranc injuries remain challenging, and the optimal surgical strategy between open reduction and internal fixation (ORIF) and primary arthrodesis remains controversial. This study compared functional outcomes, pain, complications, reoperations, and operative time between the two techniques. Methods: This retrospective cohort study included 60 adults with acute Lisfranc injuries treated surgically between 2008 and 2023. Forty-two patients underwent ORIF and 18 underwent primary arthrodesis. Mean follow-up was 3.4 ± 1.2 years. The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score. Secondary outcomes were Visual Analogue Scale (VAS) pain, complications, reoperations, and operative time. Results: Patients in the ORIF group were significantly younger than those in the arthrodesis group (mean difference, 6.7 years; p = 0.042). Median AOFAS scores were 77 (IQR, 66–83) after ORIF and 86 (IQR, 72–89) after arthrodesis, without a statistically significant difference (p = 0.242). Arthrodesis was associated with lower VAS pain scores (mean difference, −0.7; 95% CI, −1.25 to −0.15; p = 0.013). Complications occurred in 8 patients (19.0%) after ORIF and 4 patients (22.2%) after arthrodesis. Reoperations were required in 6 patients (14.3%) and 3 patients (16.7%), respectively. Operative time was 22 minutes longer with arthrodesis (p < 0.001). Conclusions: No statistically significant differences in functional outcomes, complication rates, or reoperation rates were detected between the treatment groups. Primary arthrodesis was associated with lower postoperative pain scores and longer operative duration, although the clinical relevance of the small pain difference remains uncertain.