Authors: Nicholas Smith Craig Stone Andrew Furey
Publish Date: 2015/05/29
Volume: 474, Issue: 6, Pages: 1445-1452
Abstract
Although Lisfranc injuries are uncommon representing approximately 02 of all fractures they are complex and can result in persistent pain degenerative arthritis and loss of function Both open reduction and internal fixation ORIF and primary fusion have been proposed as treatment options for these injuries but debate remains as to which approach is betterA systematic review was performed using the Preferred Reporting Items for Systematic Reviews and MetaAnalysis PRISMA guidelines Three trials met the criteria for inclusion within the metaanalysis Qualifying articles for the metaanalysis had data extracted independently by two authors NS AF The quality of each study was assessed using the Center for Evidence Based Medicine’s evaluation strategy data were extracted from articles rated as good and fair two and one article respectivelyThe risk ratio for hardware removal was 023 95 confidence interval CI 011–045 p 0001 indicating more hardware removal for ORIF than fusion For other revision surgery the risk ratio for ORIF was 036 95 CI 008–159 p = 018 favoring neither Similarly neither was favored using patientreported outcomes the standard mean difference was calculated to be 050 95 CI −213 to 312 p = 071 When considering the risk of nonanatomic alignment neither was favored risk ratio 148 95 CI 034–638 p = 060The surgeon should consider the increased risk of hardware removal along with its associated morbidity and discuss this with the patient preoperatively when considering ORIF of Lisfranc injuries Because no new trials have been performed since 2012 further randomized controlled trials will be needed improve our understanding of these interventionsEach author certifies that he or she or a member of his or her immediate family has no funding or commercial associations eg consultancies stock ownership equity interest patent/licensing arrangements etc that might pose a conflict of interest in connection with the submitted article
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