Lisfranc ORIF vs. Fusion

A 2012 article comparing Lisfranc ORIF vs. Fusion.

Below I have also listed the other comparative studies that have been performed.

Lisfranc ORIF vs. Fusion 2012 - pdf

Lisfranc ORIF vs. Fusion 2009

Lisfranc ORIF vs. Fusion 2006

One advantage of fusion vs. ORIF is that the procedure no longer needs to be performed urgently. One caveat is the severity of the injury.  Another caveat is that patients who wait greater than 1 year - seem to have a worse outcome.  At present, the optimal time to perform surgery seems to be within 4 months of injury.

This is good for several reasons:

1) The patient can plan when they want to have the fusion.  This gives the patient time to plan ahead in regards to work, school, child care, transportation and housing arrangements.

2) The patient and surgeon are convinced that they are dealing with a true lisfranc injury.  If you have a simple metatarsal fracture this should heal within 6 to 12 weeks.  However, if the pain does not get better in this time period, and you have separation at the lisfranc ligament, there is a possibility that you have a lisfranc injury.  The recovery from any lisfranc procedure is a minimum of 6 months (typically 1 year), thus it is important to ensure you are dealing with a true lisfranc injury with the associated chronic pain before choosing surgical treatment.

3) Non-operative management has been exhausted.

4) Swelling in the foot and wound closure is no longer an issue.

5) You can take the time to find an Orthopaedic Surgeon who specializes in Foot and Ankle Surgery to perform your surgery.  If you decide to proceed with a fusion procedure I would recommend that you find an Orthopaedic Surgeon who specializes in Foot and Ankle Surgery.  The reason for this is that a Lisfranc fusion procedure is a surprisingly difficult operation to perform well.  If you proceed with a Lisfranc fusion procedure please make sure you have adqeuate amounts of Vitamin D and Calcium in your diet - to ensure that the bones fuse well.

6) Based on the articles listed above and personal experience, lisfranc fusion patients tend to have consistently better results at short and mid term follow-up.

7) If a fusion procedure is successful - no further operations are required.  With ORIF, it is often routine to remove the hardware.  Also, if the ORIF is not successful, the next option is to proceed with hardware removal, followed by a fusion procedure.  Unfortunately, at this point the patient is usually several years into their injury.

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