Reoperation Rate Differences Between Open Reduction Internal Fixation and Primary Arthrodesis of Lisfranc Injuries

Background: Controversy persists as to whether Lisfranc injuries are best treated with open reduction internal fixation (ORIF) versus primary arthrodesis (PA). Reoperation rates certainly influence this debate, but prior studies are often confounded by inclusion of hardware removal as a complication rather than as a planned, staged procedure inherent to ORIF. The primary aim of this study was to evaluate whether reoperation rates, excluding planned hardware removal, differ between ORIF and PA. A secondary aim was to evaluate patient risk factors associated with reoperation after operative treatment of Lisfranc injuries. Methods: Between July 1991 and July 2016, adult patients who sustained closed, isolated Lisfranc injuries with or without fractures and who underwent ORIF or PA with a minimum follow-up of 12 months were analyzed. Reoperation rates for reasons other than planned hardware removal were examined, as were patient risk factors predictive of reoperation. Two hundred seventeen patients met enrollment criteria (mean follow-up, 62.5 ± 43.1 months; range, 12-184), of which 163 (75.1%) underwent ORIF and 54 (24.9%) underwent PA. Results: Overall and including planned procedures, patients treated with ORIF had a significantly higher rate of return to the operation room (75.5%) as compared to those in the PA group (31.5%, P < .001). When excluding planned hardware removal, however, there was no difference in reoperation rates between the 2 groups (29.5% in the ORIF group and 29.6% in the PA group, P = 1). Risk factors correlating with unplanned return to the operation room included deep infection ( P = .009-.001), delayed wound healing ( P = .008), and high-energy trauma ( P = .01). Conclusion: When excluding planned removal of hardware, patients with Lisfranc injuries treated with ORIF did not demonstrate a higher rate of reoperation compared with those undergoing PA. Level of Evidence: Level III, retrospective comparative study

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A Comparison of Complications and Reoperations Between Open Reduction and Internal Fixation Versus Primary Arthrodesis Following Lisfranc Injury

Foot & Ankle Specialist ◽

10.1177/19386400211058264 ◽

2021 ◽

pp. 193864002110582

Author(s):

Eric So ◽

Jonathan Lee ◽

Michelle L. Pershing ◽

Anson K. Chu ◽

Matthew Wilson ◽

...

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Retrospective Chart Review ◽

Reoperation Rate ◽

Complication Rates ◽

Lisfranc Injury ◽

Significant Difference ◽

Lisfranc Injuries ◽

Reoperation Rates

There is a lack of consensus in the literature regarding optimal treatment methods for Lisfranc injuries, and recent literature has emphasized the need to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA). The purpose of the current study is to compare reoperation and complication rates between ORIF and PA following Lisfranc injury in a private, outpatient, orthopaedic practice. A retrospective chart review was performed on patients undergoing operative intervention for Lisfranc injury between January 2009 and September 2015. A total of 196 patients met the inclusion criteria (130 ORIF, 66 PA), with a mean follow-up of 61.3 and 81.7 weeks, respectively. The ORIF group had a higher reoperation rate than the PA group, due to hardware removal. When hardware removals were excluded, the reoperation rate was similar. Postsurgical complications were compared between the 2 groups with no significant difference. In conclusion, ORIF and PA had similar complication rates. When hardware removals were excluded, the reoperation rates were similar, although hardware removals were more common in the ORIF group compared with the PA group. Levels of Evidence: Level III

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Cost Comparison and Complication Rate of Lisfranc Injuries Treated with Open Reduction Internal Fixation versus Primary Arthrodesis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00122 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0012

Author(s):

Brandon Barnds ◽

William Tucker ◽

Brandon L. Morris ◽

John Paul Schroeppel ◽

Scott M. Mullen ◽

...

Keyword(s):

Internal Fixation ◽

Complication Rate ◽

Average Cost ◽

Open Reduction ◽

Open Reduction Internal Fixation ◽

Cost Of Care ◽

Hardware Removal ◽

Lisfranc Injury ◽

Hardware Complications ◽

Lisfranc Injuries

Objectives: Controversy exists regarding optimal primary management of Lisfranc injuries. Whether open reduction internal fixation or primary arthrodesis is superior remains unknown. Our retrospective study uses a private payer database to compare cost, complication rate, and hardware removal rate in Lisfranc injuries treated with primary open reduction internal fixation or primary arthrodesis. Methods: Utilizing data mining software created by a private organization, a national insurance database of approximately 23.5 million orthopedic patients was retrospectively queried for subjects who were diagnosed with a Lisfranc injury from 2007-2016 based on international classification of diseases (ICD) codes for tarsometatarsal (TMT) dislocation (PearlDiver, Colorado Springs, CO). Patients with TMT dislocations then progressed on to either non-operative treatment, open reduction internal fixation, or primary arthrodesis. Associated treatment costs based on diagnosis codes were followed after initial diagnosis and t-tests were used to determine statistical significance. Subgroups were then created based on having at least one complication ICD or current procedural terminology (CPT) code after the beginning of treatment, which included: hemorrhage, infection, nonunion, malunion, thromboembolism, wound and hardware complications, or amputation. Additionally, patients undergoing implant removal were identified by CPT code for removal of hardware performed after the index procedure. Complication and hardware removal rates were compared with chi-square test. Results: 2205 subjects with a diagnosis of Lisfranc injury were identified in the database. 1248 patients underwent non-operative management, 670 underwent open reduction internal fixation, and 212 underwent primary arthrodesis. The average cost of care associated with primary arthrodesis was greater ($5,005.82) than for open reduction internal fixation ($3,961.97, P=0.045). The overall complication rate was 23.1% (155/670) for open reduction internal fixation and 30.2% (64/212) for primary arthrodesis ( P=0.04). Rates of hardware removal independent of complications were 43.6% (292/670) for open reduction internal fixation and 18.4% (39/212) for arthrodesis ( P<0.001). Furthermore, 2.5% (17/670) patients in the open reduction internal fixation group progressed to arthrodesis at a mean of 308 days, average cost of care associated with this group of patients was $9,505.12. Conclusion: Primary arthrodesis for the management of acute Lisfranc injuries is both significantly more expensive and has a higher complication rate than open reduction internal fixation. Open reduction internal fixation demonstrated a low rate of progression to arthrodesis, although there was a high rate of hardware removal, which may represent a planned second procedure in the management of a substantial number of patients treated with open reduction internal fixation.

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Cost Comparison and Complication Rate of Lisfranc Injuries Treated with Open Reduction Internal Fixation versus Primary Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00025 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0002

Author(s):

Brandon Barnds ◽

Bryan Vopat ◽

Scott Mullen ◽

Paul Schroeppel ◽

Brandon Morris ◽

...

Keyword(s):

Internal Fixation ◽

Complication Rate ◽

Average Cost ◽

Open Reduction ◽

Open Reduction Internal Fixation ◽

Cost Of Care ◽

Hardware Removal ◽

Lisfranc Injury ◽

Hardware Complications ◽

Lisfranc Injuries

Category: Midfoot/Forefoot Introduction/Purpose: Controversy exists regarding optimal primary management of Lisfranc injuries. Whether open reduction internal fixation or primary arthrodesis is superior remains unknown. Our retrospective study uses a private payer database to compare cost, complication rate, and hardware removal rate in Lisfranc injuries treated with primary open reduction internal fixation or primary arthrodesis. Methods: Utilizing data mining software created by a private organization, a national insurance database of approximately 23.5 million orthopedic patients was retrospectively queried for subjects who were diagnosed with a Lisfranc injury from 2007-2016 based on international classification of diseases (ICD) codes for tarsometatarsal (TMT) dislocation (PearlDiver, Colorado Springs, CO). Patients with TMT dislocations then progressed on to either non-operative treatment, open reduction internal fixation, or primary arthrodesis. Treatment costs based on diagnosis codes were followed after initial diagnosis and t-tests were used to determine statistical significance. Subgroups were created based on having at least one complication ICD or current procedural terminology (CPT) code after the beginning of treatment, which included: hemorrhage, infection, nonunion, malunion, thromboembolism, wound and hardware complications, or amputation. Additionally, patients undergoing implant removal were identified by CPT code for removal of hardware performed after the index procedure. Complication and hardware removal rates were compared with chi-square test. Results: 2205 subjects with a diagnosis of Lisfranc injury were identified in the database. 1248 patients underwent non-operative management, 670 underwent open reduction internal fixation, and 212 underwent primary arthrodesis. The average cost of care associated with primary arthrodesis was greater ($5,005.82) than for open reduction internal fixation ($3,961.97, P=0.045). The overall complication rate was 23.1% (155/670) for open reduction internal fixation and 30.2% (64/212) for primary arthrodesis (P=0.04). Rates of hardware removal independent of complications were 43.6% (292/670) for open reduction internal fixation and 18.4% (39/212) for arthrodesis (P<0.001). Furthermore, 2.5% (17/670) patients in the open reduction internal fixation group progressed to arthrodesis at a mean of 308 days, average cost of care associated with this group of patients was $9,505.12. Conclusion: Primary arthrodesis for the management of acute Lisfranc injuries is both significantly more expensive and has a higher complication rate than open reduction internal fixation. Open reduction internal fixation demonstrated a low rate of progression to arthrodesis, although there was a high rate of hardware removal, which may represent a planned second procedure in the management of a substantial number of patients treated with open reduction internal fixation.

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Primary Arthrodesis Compared with Open Reduction and Internal Fixation for Lisfranc Injuries with the First Tarsometatarsal Joint Dislocation

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00132 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0013

Author(s):

Ming-Zhu Zhang ◽

Guang-rong Yu ◽

Mark Myerson

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Bodily Pain ◽

Open Reduction Internal Fixation ◽

Term Outcome ◽

Lisfranc Injury ◽

Joint Dislocation ◽

Sf 36 ◽

First Ray ◽

Lisfranc Injuries

Category: Trauma Introduction/Purpose: The first tarsometatarsal (TMT) joint is very crucial for midfoot stability. To address its importance, retrospective analyses of treatment for the first TMT joint dislocation with Lisfranc injury was performed in a multi-center manner. Comparison of open reduction internal fixation (ORIF) and primary arthrodesis was conducted for the injury. Methods: This multi-center study was involved ten clinical institutions in different area of China. .From January 2003 to June 2015, 126 Lisfranc injuries with first TMT joint dislocation underwent surgical intervention. Of this group, forty one (32.5%) feet were first TMT joint dislocation only. Eighty five feet were first TMT joint dislocation and fractures. They were 76 males (60.3%) and 50 females (39.7%) with a mean age of 45.5 (range, 20-87) years. The duration from injury to surgery is 11.7 (range, 4-26) days. Two groups were divided by surgery methods as open reduction internal fixation (ORIF) group and primary arthrodesis group. Ninety two patients were performed by ORIF, while primary arthrodesis group including 34 cases. Outcome measures included clinical examination, radiographs, AOFAS ankle-hindfoot scores, visual analogue scale (VAS) and SF-36 scores. Complications and revision rate were analyzed as well. Results: 126 patients were followed up for 29.5 months. At 1.5 years postoperatively, the AOFAS score was 79 and 85 in ORIF group and arthrodesis group.The VAS score was 3.1 separately in two groups.The mean Physical Functioning sores of SF-36 was 80.3 points and 83.5• points. The Bodily Pain score of SF-36 was 76.1 points and 84.6• points.Redislocation of first tarsometarsal joint were observed in 16 cases among ORIF group.36 patients in ORIF group had pain in midfoot, eight of them had persistent pain with the development of deformity or osteoarthrosis.No redislocation and no hardware failure was identified in arthrodesis group Conclusion: Primary stable arthrodesis of the first ray gives a better short and medium term outcome than open reduction and internal fixation for Lisfranc injury with the first ray dislocation. Possible complication and revision could be avoided by primary arthrodesis for dislocated first ray injuries.

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