Abstract / Summary
Abstract Background Three-column Lisfranc injury is a prevalent injury in midfoot that significantly affects athletes and active individuals, leading to impaired function and substantial economic burdens. This study aims to evaluate the clinical effects of primary fusion and open reduction and internal fixation in the treatment of ligamentous three-column Lisfranc injury by comparing clinical outcomes between patients in two groups. Methods A retrospective analysis of the medical records of 128 cases of ligamentous three-column Lisfranc injury with primary fusion and open reduction and internal fixation in 3 hospitals was conducted. Among them, primary fusion group contained 53 cases, and open reduction and internal fixation group contained 75 cases. There were 30 males and 23 females in the fusion group, with an average age of 37.8 years, 34 cases on the left and 19 cases on the right; the open reduction and internal fixation group had 51 males and 24 females, with an average age of 38.4 years and 48 cases on the left, 27 cases on the right. All patients with open reduction and internal fixation took out the internal fixation one year after the operation. Record the time from injury to surgery, operation time, time to return to work and occurrence of related complications for all patients. The American Orthopaedic Foot and Ankle Surgery Association (AOFAS) midfoot score, pain visual analogue scale (VAS) and SF-36 health survey summary scores were recorded at 3 months after operation and at the last follow-up. Results All patients were followed up for more than 2 years. The follow-up time of patients in the fusion group was 27.1 ± 2.2 months, while the follow-up time of the open reduction and internal fixation group was 26.9 ± 2.5 months. There was no statistical difference in gender and left and right sides between the two groups of patients (P > 0.05). There was no significant difference in age, time from injury to operation, follow-up time, and AOFAS score, VAS score, and SF-36 score in the three months after surgery(P > 0.05). The operation time, time to return to work and the AOFAS score, VAS score and SF-36 score at the last follow-up were significantly different (P < 0.05). In the fusion group, the AOFAS score, VAS score and SF-36 score of the two follow-ups were significantly different (P < 0.05). In the internal fixation group, the AOFAS scores between the two follow-ups were significantly different (P < 0.05), while the VAS score and SF-36 score were not significantly different (P > 0.05). The incisions healed in all patients after surgery. During the follow-up period, 19 patients (6 in fusion group and 13 in internal fixation group) found pain in the midfoot during walking. The 6 patients in the fusion group were all cuneiform navicular arthritis, which resolved after conservative treatment such as oral non-steroidal drugs. 13 patients in the internal fixation group were considered as Lisfranc joint traumatic arthritis or joint instability. Among them, 3 patients were relieved after conservative treatment such as oral non-steroidal drugs, and 4 patients experienced internal fixation fracture and secondary arch collapse and forefoot abduction deformity, and the other 6 patients had foot arch collapse and forefoot abduction deformity after the internal fixation was removed. The 10 patients were reoperated with fusion, and the postoperative follow-up recovered well. 30 patients (22 cases in the fusion group, 41.5%; 8 cases in the internal fixation group, 10.7%) complained of stiffness and discomfort in the midfoot. The reoperation rate in the fusion group was 0, while the reoperation rate in the internal fixation group was 13.3%. Conclusion The clinical efficacy of primary fusion in the treatment of ligamentous three-column Lisfranc injury is significantly better than open reduction and internal fixation, and it is worthy of widespread clinical promotion.