Michael P Hawkinson1, David J Tennent2, Jeffrey Belisle2, Patrick Osborn3. 1. 1 Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Ft Sam Houston, TX, USA. 2. 2 Resident, Department of Orthopaedics and Rehabilitation, SAUSHEC, Ft Sam Houston, TX, USA. 3. 3 Program Director, Department of Orthopaedics and Rehabilitation, SAUSHEC, Ft Sam Houston, TX, USA.
Abstract
BACKGROUND: Traumatic injuries to the tarsometatarsal or Lisfranc joints can be complex problems associated with long-term morbidity. Currently there is no clear consensus regarding optimal fixation methods. The purpose of this study was to evaluate the association between time from injury to treatment and treatment method with outcome. It is hypothesized that patients who underwent open reduction internal fixation (ORIF) more acutely would have higher return to duty rates. METHODS: This study is a retrospective review of 171 low-energy closed tarsometatarsal dislocations and fracture dislocations in patients identified using a Department of Defense trauma registry. Outcomes were defined as return to active duty and separation from service. Patients were categorized into cohorts by surgical treatment: ORIF, primary arthrodesis (PA), or having required a salvage arthrodesis (SA). RESULTS: The data demonstrate no significant difference between ORIF and PA as well as significantly lower return to duty rates in those who underwent SA. There was no association between increased time from injury to treatment and the observed outcomes. CONCLUSION: This study not only reinforces the importance of initial anatomic reduction and the poor outcomes of posttraumatic osteoarthritis but also suggests that SA portends poor outcomes in a highly active population. Most notably it found no significant difference in return to duty rates between ORIF and PA despite the inclusion of more "missed" and chronic injuries in the PA group. This suggests that PA may be a viable option in a young and active population regardless of treatment timing. LEVEL OF EVIDENCE: Level III, retrospective comparative series.
BACKGROUND:Traumatic injuries to the tarsometatarsal or Lisfranc joints can be complex problems associated with long-term morbidity. Currently there is no clear consensus regarding optimal fixation methods. The purpose of this study was to evaluate the association between time from injury to treatment and treatment method with outcome. It is hypothesized that patients who underwent open reduction internal fixation (ORIF) more acutely would have higher return to duty rates. METHODS: This study is a retrospective review of 171 low-energy closed tarsometatarsal dislocations and fracture dislocations in patients identified using a Department of Defense trauma registry. Outcomes were defined as return to active duty and separation from service. Patients were categorized into cohorts by surgical treatment: ORIF, primary arthrodesis (PA), or having required a salvage arthrodesis (SA). RESULTS: The data demonstrate no significant difference between ORIF and PA as well as significantly lower return to duty rates in those who underwent SA. There was no association between increased time from injury to treatment and the observed outcomes. CONCLUSION: This study not only reinforces the importance of initial anatomic reduction and the poor outcomes of posttraumatic osteoarthritis but also suggests that SA portends poor outcomes in a highly active population. Most notably it found no significant difference in return to duty rates between ORIF and PA despite the inclusion of more "missed" and chronic injuries in the PA group. This suggests that PA may be a viable option in a young and active population regardless of treatment timing. LEVEL OF EVIDENCE: Level III, retrospective comparative series.
Entities:
Keywords:
Lisfanc; arthrodesis; open reduction internal fixation; outcomes; tarsometatarsal
Authors: Kempland C Walley; Derek J Semaan; Ronit Shah; Christopher Robbins; David M Walton; James R Holmes; Paul G Talusan Journal: Foot Ankle Orthop Date: 2021-09-27