Clinical Outcomes after ORIF vs Arthrodesis for Subtle Lisfranc Injuries: A Minimum 2-Year Comparative Study

Background: Subtle Lisfranc injuries, defined by 2-5 mm of first webspace diastasis, pose unique treatment challenges distinct from more severe injuries. This study aimed to evaluate whether a primary open reduction internal fixation (ORIF) or a primary arthrodesis (PA) optimizes clinical outcomes and minimizes complications in treating subtle Lisfranc injuries. Methods: This study included patients who had a nondislocation Lisfranc injury with a proximal first webspace (between the medial cuneiform and second metatarsal base) diastasis of 2-5 mm, and underwent either a primary ORIF or primary arthrodesis. Preoperative weightbearing radiographs were reviewed to confirm subtle Lisfranc injuries. Of the 73 patients who met the inclusion criteria, 41 received a PA and 32 received an ORIF. Treatment selection was based on surgeon preference. Patient-reported outcomes via PROMIS scores were collected preoperatively and at least 2 years postoperatively. Subsequent procedures were also recorded. Results: We received PROMIS surveys from 57 patients (78%). The average preoperative diastasis of the ORIF group significantly differed from that of the PA group ( P  < .05). Both ORIF and PA cohorts demonstrated significant improvement in all physical PROMIS criteria on minimum 2-year follow-up ( P  < .05). Our results did not demonstrate a significant difference in patient-reported outcomes between the ORIF and PA groups. There was no significant difference in the incidence of complications between groups, but the ORIF group underwent significantly more hardware removal procedures than the PA group ( P  < .01). Conclusion: This study compared outcomes of subtle Lisfranc injuries treated with ORIF and PA. Our results demonstrated no significant differences between ORIF and PA outcomes. This study suggests that both ORIF and PA may be viable options for subtle Lisfranc injuries; however, further research is needed to determine which may be optimal for different patient populations. Level of Evidence: Level III, retrospective comparative study.