Trends in Surgical Management of Lisfranc Injuries: An Analysis of American Board of Orthopaedic Surgery Part II Candidates.

BACKGROUND

Historically, Lisfranc injuries have most commonly been managed by open reduction and internal fixation (ORIF). Over the past 2 decades, literature has suggested that arthrodesis, an alternative option, may be the superior surgical treatment. It is unclear, however, how much orthopaedic clinical practice has responded to the new evidence.

METHODS

We performed a retrospective review of the Part II Oral Examination Case List American Board of Orthopaedic Surgery (ABOS) database to identify Lisfranc injuries treated with ORIF or arthrodesis from 1999 to 2022. Cases performed by early-career orthopaedic surgeons were selected using relevant Current Procedural Terminology, International Classification of Diseases, Ninth (ICD-9) and Tenth Revision (ICD-10), codes corresponding to treatment with either arthrodesis or ORIF. Treatment trends were analyzed over time and stratified by surgeon fellowship training, patient age, and patient sex. Injury chronicity and specific timing from injury to surgery were not available.

RESULTS

A total of 3068 surgically managed Lisfranc injuries were identified. Of these, 574 (18.7%) were managed with arthrodesis and 2494 (81.3%) with ORIF. The rate of arthrodesis increased over time: from 7.7% (95% CI 6.3-9.3) in 1999-2009 to 20.7% (95% CI 18.5-23.1) in 2010-2017 (P < .0001) and to 37.0% in 2018-2022 (95% CI 33.3-40.9) (P < .0001). The rate of arthrodesis was higher among cases performed by foot and ankle-trained orthopaedists (30.3% vs 7.9% of all other sub-specialties), in female patients (22.4% vs 15.9% in males), and in older patients (27.8% of patients >50 years vs 15.4% of patients ≤50 years).

CONCLUSION

Although still the less utilized approach, arthrodesis for Lisfranc injuries has increased substantially among early-career orthopaedic surgeons in parallel to emerging evidence. This trend is more apparent among foot and ankle specialists.

LEVEL OF EVIDENCE: Level III, therapeutic.