Biomedical Letters

Definitive treatments for Lisfranc injury: A systematic review and meta-analysis

Sah Sanjaya, Ren Haoyang, Yu Tao, Zhang Mingzhu, Chen Kai, Li Bing, Feng Jun, Zhao Youguang, Yang Yunfeng, Yu Guangrong*

Department of Orthopaedic, Foot and Ankle Surgery, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China.

Abstract

To prevent the risk of post traumatic long term sequelae of Lisfranc injury early recognition and expeditious surgical interventions are essence of need. There have been two contemplated ways of intervention, open reduction and internal fixation and Arthrodesis. Still, argument remains for better approach. In this study, a comprehensive search was carried out on PubMed, Web of Science, Cochrane database Library and google scholar for studies on surgical treatment of tarsometatarsal/lisfranc injury advocated on (a) anatomic alignment (b) postoperative complication (c) re-surgery after postoperative complication (d) implant removal and (e) clinical outcome. Systematic meta-analysis was performed by the help of basic guidelines of Preferred Reporting Items for Systematic Review and Mata-Analysis (PRISMA). Four potential studies with 146 patients were included in current meta-analysis. None of the proposed surgery had better outcome with nonanatomic alignment, the risk ratio 1.01 [95% CI, 0.92, 1.12; Test for overall effect: Z = 0.26 (P = 0.80)]. Here risk ratio for postoperative complication was 1.31 [95% CI, 0.78, 2.20; Test for overall effect: Z = 1.04 (P = 0.30)] indicating favoring neither ORIF nor arthrodesis. In the same way risk ratio for re-surgery for postoperative complication was 0.39 [95% CI, 0.12, 1.26; Test for overall effect: Z = 1.58 (P = 0.11)]. For implant removal risk ratio was calculated to be 0.14 [95% CI, 0.04, 0.50 Test for overall effect: Z = 3.05 (P = 0.002)] which indicates frequency of hardware removal was significantly soar on Open Reduction and Internal Fixation (ORIF) group while in arthrodesis it was quite low. Statistically clinical outcome of standard mean difference was 0.54 [95% CI, -1.97, 3.05 Test for overall effect: Z = 0.42 (P = 0.67)] which indicates none of intervention was on favor. Based on the currently available statistical analysis, it was justice on the favor of arthrodesis for Lisfranc injuries in terms of anatomical alignment, implant removal, or outcome score. Arthrodesis was comparatively more beneficial for severe Lisfranc injury with complete ligamentous involvement. For further more improvements prospective randomized controlled trial will be needed with American Orthopedic Foot & Ankle Society (AOFAS) score.

Keywords: Lisfranc injury, tarsometatarsal, fracture dislocation, arthrodesis, open reduction & internal fixation, meta-analysis

Received August 16, 2015 Revised September 11, 2015 Accepted September 21, 2015

*Correspondence: Yu Guangrong Email: yuguangrong@hotmail.com Phone: +86 139-0168-2246