Open reduction and internal fixation is currently the accepted treatment
for displaced Lisfranc joint injuries. However, even with anatomic reduction
and stable internal fixation, treatment of these injuries does not have
uniformly excellent outcomes. The objective of this study was to compare
primary arthrodesis with open reduction and internal fixation for the
treatment of primarily ligamentous Lisfranc joint injuries.
Forty-one patients with an isolated acute or subacute primarily ligamentous
Lisfranc joint injury were enrolled in a prospective, randomized clinical
trial comparing primary arthrodesis with traditional open reduction and
internal fixation. The patients were followed for an average of 42.5 months.
Evaluation was performed with clinical examination, radiography, the American
Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, a visual analog pain
scale, and a clinical questionnaire.
Twenty patients were treated with open reduction and screw fixation, and
twenty-one patients were treated with primary arthrodesis of the medial two or
three rays. Anatomic initial reduction was obtained in eighteen of the twenty
patients in the open-reductio group and twenty of the twenty-one in the
arthrodesis group. At two years postoperatively, the mean AOFAS Midfoot score
was 68.6 points in the open-reduction group and 88 points in the arthrodesis
group (p < 0.005). Five patients in the open-reduction group had persistent
pain with the development of deformity or osteoarthrosis, and they were
eventually treated with arthrodesis. The patients who had been treated with a
primary arthrodesis estimated that their postoperative level of activities was
92% of their preinjury level, whereas the open-reduction group estimated that
their postoperative level was only 65% of their preoperative level (p <
A primary stable arthrodesis of the medial two or three rays appears to
have a better short and medium-term outcome than open reduction and internal
fixation of ligamentous Lisfranc joint injuries.