Anatomic reduction cited as factor for osteoarthritis following ORIF of a Lisfranc injury

COPENHAGEN, Denmark — Anatomic reduction is the most influential factor affecting the incidence of osteoarthritis in patients who undergo open reduction and internal fixation of a Lisfranc injury, according to a recently presented study.

Farshad Adib, MD, shared his team’s findings at the 12th EFORT Congress 2011.

Although previous reports have listed a 14% to 94% incidence of osteoarthritis (OA) following open reduction and internal fixation (ORIF) of a Lisfranc injury, Adib said, his team sought to investigate the influence of various factors on the OA rate.

Inclusion criteria

The study included patients with dislocation of greater than 2 mm who underwent ORIF.

“Patients who were diagnosed after 6 weeks were excluded,” Adib said. “Patients diagnosed within the first week were considered as acute diagnoses, and patients diagnosed between the first and sixth weeks were considered delayed diagnoses.”

Additional classifications included anatomic or non-anatomic reduction, open or closed fractures, and the presence of other fractures. Patients who had less than 2 mm of displacement after the procedure were considered to have had an anatomic reduction. Ninety-four patients underwent ORIF and met the study criteria, Adib reported, but 44 were available for follow-up.

OA rates

The investigators found that an anatomic reduction was achieved in 77% of patients. The overall incidence of OA was around 45%, with 22% of patients undergoing secondary arthrodesis during the research period.

Twenty of the 44 patients had post-traumatic OA.

“The incidence of [OA] was not significantly different between open fractures and closed fractures,” Adib said. “Also, the differences were not significant between acute diagnosis and delayed diagnosis. Further, having a co-fracture does not have influence on the incidence of [OA].”

Adib reported that the only influential factor was anatomical reduction.

“The difference between incidence of [OA] between anatomical reduction and non-anatomical reduction was statistically significant,” he said, noting that 35% of patients with anatomic reduction displayed OA, compared with 80% of those who had a non-anatomic reduction.

Lisfranc injury difficulties

“Overall, the incidence of [OA] after ORIF is high,” Adib said. “It is about 45% in our study. I think a randomized, clinical trial study to compare other options, like external fixation or primary arthrodesis, could be the direction of the future.”

It is also important to keep in mind the difficulty of diagnosing Lisfranc injuries, Adib added.

“Lisfranc injury is often misdiagnosed, so in any suspicious mechanism, it is a diagnosis to keep in mind,” he concluded. “Take weight bearing X-rays. ORIF and delayed diagnosis for up to 6 weeks can have good results. It is also important to know that the only factor that influences the incidence of [OA] is anatomical reduction, so intraoperative X-rays should be as anatomical as possible.” – by Robert Press

Reference:

• Adib F, Medadi F, Guidi E, et al. Osteoarthritis following open reduction and internal fixation of the Lisfranc injury. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen, Denmark.

• Farshad Adib, MD, can be reached at farshad333@yahoo.com.
• Disclosure: Adib has no relevant financial disclosures.