Internal fixation or primary arthrodesis for Lisfranc complex joint injuries? A meta-analysis of comparative studies.

Though uncommon, Lisfranc complex joint injuries constitute a therapeutic challenge. Two surgical methods are commonly used to treat such injuries: open reduction and internal fixation (ORIF) and primary arthrodesis (PA). The aim of this meta-analysis is to look for significant differences in the outcomes between these two techniques.A comprehensive search of databases including PubMed, Embase, Cochrane Library and Google Scholar was planned. Only studies with comparative design using ORIF/PA techniques were included. One randomized trial, one quasi-randomized trial and four of retrospective comparative studies met the inclusion criteria. Proportion meta-analysis was used to look for weighted frequencies of outcomes. Risk difference rate meta-analysis was conducted to look for significant differences between proportion rates.The pooled sample included 269 patients [269 surgical procedures: 176 (65.4%) ORIF vs. 93 (34.6%) PA] with a mean follow-up period of 31.85 ± 16.14 months. Besides a similar radiological healing failure rate, meta-analytical results yielded better outcomes in favour of PA: lesser implant removal rate (P < 0.0001), better rate of return to full activities (P = 0.01) and satisfaction rate (P = 0.052). A double rate of revision for non-healing following ORIF was found but did not reach significance (P = 0.1).This meta-analysis demonstrated that even with a similar union rate, PA could be a better option in treating Lisfranc complex joint injuries when compared to ORIF. There is a need for larger controlled sampled studies to research on this type of injuries.