Internal fixation or primary arthrodesis for Lisfranc complex joint injuries? A meta-analysis of comparative studies
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Though uncommon, Lisfranc complex joint injuries constitute a therapeutic challenge. Two surgical methods are commonly used to treat such injuries: open reduction and internal fixation (ORIF) and primary arthrodesis (PA). The aim of this meta-analysis is to look for significant differences in the outcomes between these two techniques.
A comprehensive search of databases including PubMed, Embase, Cochrane Library and Google Scholar was planned. Only studies with comparative design using ORIF/PA techniques were included. One randomized trial, one quasi-randomized trial and four of retrospective comparative studies met the inclusion criteria. Proportion meta-analysis was used to look for weighted frequencies of outcomes. Risk difference rate meta-analysis was conducted to look for significant differences between proportion rates.
The pooled sample included 269 patients [269 surgical procedures: 176 (65.4%) ORIF vs. 93 (34.6%) PA] with a mean follow-up period of 31.85 ± 16.14 months. Besides a similar radiological healing failure rate, meta-analytical results yielded better outcomes in favour of PA: lesser implant removal rate (P < 0.0001), better rate of return to full activities (P = 0.01) and satisfaction rate (P = 0.052). A double rate of revision for non-healing following ORIF was found but did not reach significance (P = 0.1).
This meta-analysis demonstrated that even with a similar union rate, PA could be a better option in treating Lisfranc complex joint injuries when compared to ORIF. There is a need for larger controlled sampled studies to research on this type of injuries.
KeywordsLisfranc injury Primary arthrodesis Open reduction and internal fixation
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The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 14.Adib F, Medadi F, Guidi E, Harandi AA, Reddy C. Osteoarthritis following open reduction and internal fixation of the Lisfranc injury. Paper presented at: 12th EFORT congress; June 1–4, 2011. http://www.ors.org/Transactions/57/1381.pdf. Accessed May 26, 2018.