title: Comparison of Arthrodesis and Non-fusion to Treat Lisfranc Injuries.
abstract: OBJECTIVE
  "Lisfranc joint injury" is comprised of a tarsometatarsal joint-complex injury. The Lisfranc complex injury is always a challenge for orthopedists, and the optimum treatment is still up for debate. Anatomic reduction and stable internal fixation prove to have no satisfactory outcomes. This research aims to compare the clinical curative effects, complications and radiographic features of arthrodesis and non-fusion of the Lisfranc joint in the follow-up of the patients who suffered Lisfranc injuries.
  
  
  METHODS
  A comparative retrospective study of 25 patients with acute or subacute Lisfranc complex injuries was conducted between September 2013 and March 2015 in the First Affiliated Hospital of Soochow University. All patients were classified by Myerson classification. Eight patients were treated with arthrodesis, while 17 patients received non-fusion operations. The clinical curative effects, complications and image differences were compared between the two groups. American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, Short Form-36 (SF-36) and Visual Analogue Scale (VAS) score were evaluated for each patient during the follow-up. All statistics were analyzed using the SPSS software system.
  
  
  RESULTS
  All fractures healed for both the arthrodesis group and the non-fusion group. Patients in the arthrodesis group had a higher AOFAS score compared with patients in the non-fusion group (94.00 vs. 88.58, P = 0.034). Complications occurred in eight patients (8/17, 47%) in the non-arthrodesis group, including the second and third phalanx abduction (1), talipes cavus (2), eversion deformity of front foot (3), eversion deformity of calcaneus (1), as well as postoperative infection (1). Only two patients (2/8, 25%) in the arthrodesis group suffered complications. One was a limitation of motion of the front foot and pain during walking; the other was an eversion deformity of front foot.
  
  
  CONCLUSIONS
  Primary arthrodesis has advantages compared to primary open reduction and internal fixation (ORIF): reduced foot deformity rates, sustained biomechanical morphology of the feet, reduced complications, higher level of function recovery, shorter time of surgical procedures, fewer complications, higher AOFAS score and fewer frequency of complications. According to our research, primary arthrodesis may be a better choice for treating Lisfranc injury.
authors.affiliation: Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China.
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Qiao
authors.affiliation: Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China.
authors.forename: Jun-Kun
authors.initials: JK
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Shen
authors.affiliation: Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China.
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Bao
authors.affiliation: Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Jiang
authors.affiliation: Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Chemical Engineering, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Wasim
authors.initials: W
authors.lastname: Kapadia
authors.affiliation: Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China.
authors.forename: Hong-Tao
authors.initials: HT
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China.
authors.forename: Hui-Lin
authors.initials: HL
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods*; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D011182:Postoperative Care / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Arthrodesis; Lisfranc injury; Non-fusion