A systematic review and meta -analysis of the treatment of acute lisfranc injuries: Open reduction and internal fixation versus primary arthrodesis

被引:22
作者
Alcelik, Ilhan [1 ]
Fenton, Carl [1 ]
Hannant, Gary [2 ]
Abdelrahim, Musaab [1 ]
Jowett, Charlie [1 ]
Budgen, Adam [1 ]
Stanley, James [1 ]
机构
[1] York Hosp, York Teaching Hosp NHS Fdn Trust, Wigginton Rd, York YO31 8HE, N Yorkshire, England
[2] Leighton Hosp, Mid Cheshire Hosp NHS Fdn Trust, Crewe CW1 4QJ, Cheshire, England
关键词
Lisfranc; TMTJ; Tarsometatarsal joint complex; Foot; Trauma; Fracture; Sports injuries; Meta-analysis; Review; TARSOMETATARSAL JOINT; DISLOCATIONS; OUTCOMES;
D O I
10.1016/j.fas.2019.04.003
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Injuries to the Lisfranc complex, although relatively rare carry a high morbidity and are often associated with other injuries. Despite a number published studies to determine the best operative management, there is an ongoing debate to whether open reduction and internal fixation (ORIF) or primary arthrodesis (PA) produces the best outcomes for patients. There have been further studies published in the last few years that have not been assessed as part of the wider literature and therefore we wished to perform an updated systematic review and meta -analysis with inclusion of outcomes not assessed in the previous studies. Methods: We performed a structured search for retrospective and prospective comparative papers and identified 8 relevant articles (2 RCT studies and 6 non-RCT studies) that compared the outcomes of ORIF versus PA; these studies included a total of 547 patients. Each of the studies was assessed for suitability and quality before inclusion. We performed a statistical analysis of the aggregated results as part of the review. Results: We found no statistically significant difference between the outcomes of ORIF versus PA in terms of return to work or activity (Odds Ratio 0.80 (CI 95%, 0.32 -2.02, P = 0.64)) and satisfaction rates (Odds Ratio 0.15 (CI 95%, 0.01 -.0 0, P = 0.25)). Patients undergoing ORIF have a higher risk of undergoing further surgery to remove the metalwork (Odds Ration 13.13 (CI 95%, 7.65 -22.54, P < 0.00001)) or to undergo secondary fusion, but, the overall complication rates appear to be equivalent in both groups (risk difference 0.03 (CI 95%, -0.15 -0.21, P = 0.76)). Conclusions: Although there were no significant differences in the functional outcomes, the overall power of the studies is low. The rates of metalwork removal and secondary fusion were higher in the ORIF group and this risk should be presented to the patient when counselling them for any procedure. We noted that there is a high level of heterogeneity in the type of injuries and measured outcomes included in each study and, therefore, further trials are needed to determine the best treatment across the spectrum of Lisfranc complex injuries. (C) 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:299 / 307
页数:9
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