Comparing ORIF and Primary Fusion for Lisfranc Fracture-Dislocations: A Retrospective Analysis

A retrospective analysis of 90 patients undergoing surgery for Lisfranc injuries between 2016 and 2023 found no statistically significant differences in key clinical outcomes between those treated with open reduction internal fixation (ORIF) and those who underwent primary arthrodesis (PA).

The study reported comparable rates of return to full weight bearing and complications, including revision surgery and infection. Although the ORIF group (n = 69) had a higher rate of hardware removal (33.8%) compared with PA (n = 21; 19%), and PA had a higher overall complication rate (35.0% vs 17.6% for ORIF), neither difference reached statistical significance.

Lisfranc fracture-dislocations represent a rare but serious traumatic injury, occurring in approximately 0.2% of all fractures. These injuries are misdiagnosed in up to 20% of cases and require timely intervention to prevent long-term sequelae. ORIF and PA are both widely used surgical approaches, but controversy remains regarding which technique offers superior outcomes.

The study involved a retrospective chart review of patients treated surgically for Lisfranc injuries between January 2016 and December 2023. Patients younger than 18 years of age, those with polytrauma, and those managed nonoperatively were excluded. Injuries were classified using the Hardcastle classification system, and statistical analyses—including Mann-Whitney U tests, t-tests, and Pearson chi-squared tests—were performed to compare demographic and clinical outcomes between groups. A significance level of P < .05 was used.

Among the 90 patients meeting inclusion criteria, no statistically significant differences were found between the ORIF and PA groups regarding age, BMI, demographics, Hardcastle classification, or time to return to full weight bearing. The ORIF group had a higher rate of hardware removal, while the PA group had a higher overall complication rate, but neither reached statistical significance. These findings suggest that both surgical approaches yield comparable outcomes regardless of injury classification.

“There was no statistically significant difference in outcomes between ORIF vs PA for Lisfranc injuries, indicating that either treatment can provide similar outcomes regardless of the injury classification,” the authors concluded.

Reference:
Iqbal F, Patel D, Puli A, Hunter K, Gentile P, Gorda S. Surgical options for traumatic Lisfranc fracture dislocation: ORIF vs primary fusion. Presented at: American College of Foot and Ankle Surgeons Scientific Conference; March 27-30, 2025; Phoenix, AZ. Accessed March 17, 2025. https://imis.acfas.org/ACFAS2025/ACFAS2025/Abstracts.aspx?hkey=5209f2e8-69fc-4935-8823-799c8f5c2922