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Lisfranc injuries with dislocation the first tarsometatarsal joint: primary arthrodesis or internal fixation (a randomized controlled trial)

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Abstract

Background

Open reduction and internal fixation (ORIF) is a popular method for treatment of displaced Lisfranc injuries. However, even with anatomic reduction and solid internal fixation, treatment does not provide good outcomes in certain severe dislocations. The purpose of this study was to compare ORIF and primary arthrodesis (PA) of the first tarsometatarsal (TMT) joint for Lisfranc injuries with the first TMT joint dislocation.

Methods

Seventy-eight Lisfranc injuries with first TMT joint dislocation were finally enrolled and analyzed in a prospective, randomized trial comparing ORIF and PA. They were 50 males and females with a mean age of 40.7 years and randomized to ORIF group and PA group. Outcome measures included radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale, Foot and Ankle Ability Measure (FAAM) Sports subscale, visual analog scale (VAS), and the 36-Item Short Form Health Survey (SF-36). Complications and revision rate were also analyzed.

Results

Forty patients were treated by ORIF, while PA group includes 38 cases. Patients were followed up for 37.8(range, 24–48) months. At final follow-up, the mean AOFAS midfoot score (P < 0.01), the FAAM Sports subscale (P < 0.01), the physical function score (P < 0.05), and the Bodily Pain score of SF-36 (P < 0.05) after ORIF treatment were significantly lower than PA group. The mean VAS score in ORIF group was higher (P < 0.01). In ORIF group, redislocation of the first TMT joint was observed in ten cases, and thirteen patients had pain in midfoot. No redislocation and no hardware failure were identified in PA group.

Conclusion

PA of the first TMT joint provided a better medium-term outcome than ORIF for Lisfranc injuries with the first TMT dislocation. Possible complications and revision could be avoided by PA for dislocated first ray injuries.

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Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Natural Science Foundation of Beijing (No. 7212020), the Science and Technology Planning Project of Beijing Municipal Education Commission (No. KM202110025013), and the Beijing Thousand Talents Project (No. 2020A43).

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Authors and Affiliations

  1. Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No.1, Dong Jiao Min Lane, Dong Cheng District, Beijing, 100730, China

    Chengyi Sun & Mingzhu Zhang

  2. Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310000, China

    Xudong Miao

  3. Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China

    Yunfeng Yang & Guangrong Yu

  4. Foot and Ankle Surgery Department, Honghui Hospital of Xi’an Jiaotong University, Xi’an, 710054, China

    Hongmou Zhao

  5. Department of Orthopedic Trauma, The First Affiliated Hospital of Dalian Medical University, Dalian, 201318, China

    Xin Tang

Authors
  1. Chengyi Sun
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  2. Xudong Miao
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  3. Mingzhu Zhang
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  4. Yunfeng Yang
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  5. Hongmou Zhao
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  6. Xin Tang
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  7. Guangrong Yu
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Chengyi Sun, Mingzhu Zhang, and Xudong Miao. The first draft of the manuscript was written by Chengyi Sun, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mingzhu Zhang.

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Ethics approval

This clinical trial was performed in line with the principles of the Declaration of Helsinki and was registered in Clinical trials. org (ID: ChiCTR1800020466).

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The authors declare no competing interests.

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Sun, C., Miao, X., Zhang, M. et al. Lisfranc injuries with dislocation the first tarsometatarsal joint: primary arthrodesis or internal fixation (a randomized controlled trial). International Orthopaedics (SICOT) 46, 2529–2537 (2022). https://doi.org/10.1007/s00264-022-05478-y

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  • DOI: https://doi.org/10.1007/s00264-022-05478-y

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