Bridge plating and primary arthrodesis show similar outcomes for Lisfranc stabilization
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Both temporary bridge plating and primary arthrodesis had “good outcome scores” in the treatment of Lisfranc injuries, according to published results.
While temporary bridge plating (BP) resulted in better alignment of the first metatarsal, this stabilization technique also resulted in a high incidence of radiographic osteoarthritis.
According to the study abstract, researchers analyzed 48 patients with Lisfranc injuries. Of these patients, 24 patients were treated with primary arthrodesis (PA) and 24 patients had BP. Researchers analyzed results using three outcome parameters: the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scale, the SF-36 and VAS for pain.
“The mean AOFAS midfoot score 2 years postoperatively was 89 in the PA group and 85 in the BP group,” the researchers wrote in the abstract. “There were no significant differences between the groups with regard to SF-36 or VAS pain scores. The alignment of the first metatarsal was better in the BP group than in the PA group,” they added.
However, at the 2-year postoperative CT scan, the BP group exhibited a higher incidence of radiographic OA than the PA group.
“We were not able to detect superiority of the BP group compared to the PA group using AOFAS midfoot score, VAS pain score or SF-36 at 2-year follow-up,” the researchers concluded in the study.
Perspective
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Andrew R. Hsu, MD
What is the importance of saving the first tarsometatarsal joint in Lisfranc injuries? Are H. Stødle, MD, and colleagues compared primary fusion of the medial three tarsometatarsal joints (lag screws) to first tarsometatarsal bridge plating with combined fusion of the second/third tarsometatarsal joints (hybrid construct). While there were no significant differences in clinical outcome scores, roughly half of the bridge plating group showed evidence of first tarsometatarsal arthritis on final follow-up, raising the question of if and when they will need an additional first tarsometatarsal fusion in the future.
While there weren’t statistically significant differences in complication rates between groups, it’s important to highlight that in the bridge plating group, one patient had a wound infection, two developed complex regional pain syndrome, one had an extensor hallucis longus tendon rupture due to hardware, two had nonunions in the third tarsometatarsal joint and five required hardware removal in addition to planned bridge plate removal (46% total complications).
I believe that primary midfoot fusion "fix and fuse" of the medial three tarsometatarsal joints with low-profile implants, such as Nitinol staples (my preferred technique), to minimize hardware irritation is superior to hybrid fixation of bridge plates with partial midfoot fusion. We regularly sacrifice the first tarsometatarsal joint during Lapidus procedures for bunion correction and the literature has shown good outcomes of this procedure when fusion is achieved. Therefore, I don’t think much is to be gained in unstable Lisfranc injuries by saving the first tarsometatarsal joint if you are going to fuse the second/third tarsometatarsal joints at the same time. I think the overarching idea that Lisfranc low-energy injuries equal open reduction internal fixation bridge plating/screws and high-energy injuries equal primary fusion, still holds true today.
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