How Fragile is the Available Data on ORIF Versus Primary Arthrodesis for Lisfranc Injury?

A team of researchers sought to evaluate the strength of the available research on open reduction and internal fixation (ORIF) versus primary arthrodesis for Lisfranc injuries. In a recent online-first publication from Foot and Ankle International, the authors included all applicable comparative studies on the subject through October 2023. They extracted key data before calculating fragility index and continuous fragility index, among other statistical analyses.¹

Despite rather robust literature, there remains debate between the best surgical pathway for Lisfranc injuries. These authors aimed to look at the sum total of the research from a different angle, specifically, how to interpret statistical significance in the context of conflicting studies. As a result, they worked towards presenting clarity in the statistics and in the debate itself. Their initial hypothesis cited a goal to “offer clinically relevant insight when interpreting conflicting outcomes regarding ORIF vs PA management of Lisfranc injuries.”¹

After initially screening over 200 studies, they included 10 studies and 67 outcomes. Four such studies contended that primary arthrodesis had superior outcomes to ORIF. They found that 3 of them to be statistically robust. The 6 remaining studies cited primary arthrodesis and ORIF as having no difference in outcomes, however, the authors found 2 of the 6 to be robust.¹

The analysis remarked that each of these studies warrant individual consideration, but concluded that the studies that support superiority of the primary arthrodesis in these cases were indeed statistically robust. When looking more closely at other individual outcomes, they did note moderate fragility in some areas, including functional score, return to function, and wound complications.¹

Reference

1. Ahn BJ, Quinn M, Zhao L, etc. Statistical Fragility Analysis of Open Reduction Internal Fixation vs Primary Arthrodesis to Treat Lisfranc Injuries: A Systematic Review. Foot Ankle Int. 2024 Feb 8:10711007231224797.