Primary Fusion Vs. ORIF LisFranc

Since the 2006 landmark Coetzee study that favored primary fusion, the topic has been a point of debate at foot and ankle meetings. In their paper, 41 patients with an isolated acute or subacute primarily ligamentous Lisfranc joint injury were involved in a prospective, randomized clinical trial comparing primary arthrodesis (PA) with traditional open reduction and internal fixation (ORIF). The authors concluded that a primary stable arthrodesis of the medial two or three rays seems to yield better short and medium-term outcomes compared to open reduction and internal fixation for ligamentous Lisfranc joint injuries.

Counter point (2024)

Ponkilainen et al. conducted a national multicenter, randomized controlled trial that focused on 43 displaced Lisfranc injuries. The primary outcome measure was the Visual Analogue Scale for Foot and Ankle (VAS-FA) at a 24-month follow-up. The study found no evidence of a difference in VAS-FA between ORIF and PA for patients with displaced Lisfranc injuries. Therefore, both surgical methods are considered viable options for initial treatment.

Standard of care (SOC) 2024

There is no SOC with respect to fusion vs primary ORIF of Lisfranc in 2024, but we predict many more years of passionate debate.