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Equivalent functional outcome scores and hardware removal rates
10%
284/2884
Fixation has better functional outcome scores than arthrodesis
5%
146/2884
Arthrodesis has better functional outcome scores than fixation
39%
1125/2884
Fixation has higher hardware removal rates than arthrodesis
43%
1252/2884
Arthrodesis has higher hardware removal rates than fixation
1%
31/2884
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When comparing fixation versus primary fusion in the treatment of Lisfranc injuries of the foot, fixation consistently has significantly higher removal of hardware rates than primary fusion. Level 1 randomized trials have been conducted comparing open reduction and internal fixation (ORIF) versus primary fusion in the treatment of LIsfranc injuries. In regards to outcomes, results are mixed. A constant throughout the trials, however, is the significantly higher hardware removal rate following ORIF when compared to primary fusion. Rammelt et al. conducted a cohort comparison between ORIF and delayed fusion (22 patients in each group) with a mean follow-up of 36 months. The authors here reported superior results for ORIF over fusion, improved outcome scores and satisfaction with earlier return to work, especially in the early follow-up period. Smith et al in a recent systematic review and meta-analysis compared ORIF vs primary fusion, compiling results from 3 level 1 randomized trials. There was no significant difference between ORIF and primary fusion in regards to patient reported outcomes, but a significantly increased risk of subsequent hardware removal following ORIF was noted. Ly et al. conducted a prospective randomized trial comparing ORIF vs primary fusion and reported significantly better patient reported outcomes for fusion in both the short-term and mid-term follow-up time points. ORIF also had a significantly higher rate of hardware removal. Henning et al. conducted a prospective randomized trial comparing ORIF vs primary fusion, with planned removal of hardware for the ORIF group. Here, short term and midterm results were equivalent and with planned hardware removal in the fixation group, hardware removal rates were comparable to primary fusion patients. Figure A is an anteroposterior radiograph exhibiting a ligamentous Lisfranc injury. Incorrect answers: Answers 1-3, 5: Depending on the study, outcomes are either equivalent, favor fusion, or favor fixation. The only consistent significant difference between the two treatments is the significantly higher rate of hardware removal for the fixation group compared to the fusion group. It is important to note that these studies do not use headless screws or bioabsorbable screws for fixation.
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