Do Lisfranc ORIFs fail? Low long-term conversion to arthrodesis in the largest ORIF-specific cohort to date.

BACKGROUND

Lisfranc injuries are uncommon but potentially debilitating midfoot injuries associated with chronic pain, arthritis, and gait dysfunction. Open reduction and internal fixation (ORIF) is commonly performed for unstable injuries, yet concerns remain regarding fixation failure and subsequent need for arthrodesis. However, large-scale data defining mid- and long-term conversion rates to arthrodesis after primary ORIF are limited.

METHODS

A retrospective cohort study was performed using the TriNetX Research Network to evaluate adults undergoing ORIF of Lisfranc injuries between 2005 and 2025, identified by CPT code 28615. Postoperative outcomes were evaluated at 5 and 10 years. Primary outcomes included reoperation rates, specifically hardware removal and secondary midfoot arthrodesis. Secondary outcomes included postoperative infection and gait abnormalities. Kaplan-Meier survival analyses were used to estimate event-free survival.

RESULTS

A total of 8101 patients met inclusion criteria. Hardware removal was the most frequent cause of reoperation, occurring in 19.4 % of patients at 5 years and 19.8 % at 10 years. Secondary arthrodesis was less common, occurring in 2.7 % and 2.8 % of patients at 5 and 10 years, respectively. Postoperative infection occurred in 2.0 % of patients at 5 years and 2.2 % at 10 years, and abnormal gait was documented in 4.9 % and 5.3 % of patients at 5 and 10 years, respectively. Event-free survival remained high for arthrodesis and infection (>95 %), whereas hardware retention progressively declined over time.

CONCLUSION

In the largest ORIF-specific cohort to date, reoperation following Lisfranc ORIF was common and largely driven by hardware removal, affecting nearly one in five patients at both five and ten years. In contrast, secondary arthrodesis and postoperative infection were infrequent. The low rate of conversion to fusion suggests that joint-preserving fixation is structurally durable for most patients, supporting ORIF as a viable and lasting first-line operative strategy despite a meaningful implant-related reoperation burden.

LEVEL OF EVIDENCE: Level III, retrospective cohort study.