Vinay Matai Journal Club 10/9/13

Purpose
To test the hypothesis that treatment of highenergy ligamentous LisFranc injuries with primary open reduction and internal fixation would have the same or better functional short and medium-term outcomes as treatment with a primary partial arthodesis. Level I Study No Disclosures by authors

Methods and Materials

Level of Evidence: I Study Type: Prospective Sample Size: 41 patients(Mar 1998 Jan 2002) Follow up: 2w, 6w, 3m, 6m, 1yr, 2yr Groups: Arthrodesis vs Open Reduction Randomization: Even-Odd Numbering Patient Questionnaire
Satisfaction Pain (0-10) % of improvement in activity

Inclusion Criteria
Include all injuries that were seen up to one month after the accident, although all forty-one patients had the surgery within three weeks from the date of injury and most had it within the first week. The Lisfranc joint injury had to be primarily ligamentous, with no major fractures present

Exclusion Criteria
Comminuted intra-articular fracture at the base of the 1st or 2nd mets Other substantial foot, ankle, or leg injury Previous attempt at sx management of the same injury T1DM Ipsilateral ankle fusion PVD PN RA

Arthrodesis SX: Primary arthrodesis of the medial two or three rays 20 patients 13 men and 7 women MOI: MVC, snowmobile, or all-terrain-vehicle accident, fall from height, sports Mean Age: 32.4 (19-52) Follow up: 42 months

ORIF Sx: Open Reduction with screw fixation of medial two or three rays. 21 patients 14 men and 7 women MOI: MVC, snowmobile, or dirt-bike accident, fall from height, horse, deep hole Mean Age: 32 (19-42) Follow up: 43.4 Months

*Post-Op: Short leg splint for 2 weeks NWB followed by short leg cast for 4-6 weeks NWB. Advanced to FWB over next 4 weeks in boot. PT at week 6-10.

Results
Arthodesis
Sample Size: 21 Fusion @ 10.6 weeks 19pts had uncomplicated fusion but 4 needed 2nd surgery for HR (6.5m) 1 pt needed a bone stim healed 1 required revision with bonegrafting and fusion healed 1 pt with compartment syndrome healed

ORIF Sample Size: 20 16 underwent second surgery for HR (6.75m) Xray: loss of correction, increasing deformity, DJD in 15pts 5 pts tarsometatarsal arthodesis 2 scheduled for arthrodesis

5 out of 6 patients that were dissatisfied underwent an arthrodesis and were satisfied

ORIF: Only 6/20 were able to return to pre-injury level Arthodesis: 15/21 patients were able to return to pre-injury level

AOFAS and Pain Score

Arthodesis AOFAS: 88 @ 2 year AOFAS: 86.9 @ 43 months ORIF AOFAS: 68.6 @ 2 year AOFAS: 57.1 @ 42 months 3 of the 5 that had the conversion their AOFAS score was 79.0

Limitations
Open-Randomization Surgeon performed f/u exam Comparison to patients with osseous deformity