Cost Comparison and Complication Rate of Lisfranc Injuries Treated - PowerPoint PPT Presentation

Cost Comparison and Complication Rate of Lisfranc Injuries Treated with Open Reduction Internal Fixation versus Primary Arthrodesis Brandon Barnds, MD Kansas University Medical Center Department of Orthopedic Surgery December 9, 2017

Acknowledgements • Co-Authors: William Tucker, MD Brandon Morris, MD Armin Tarakemeh, BA John Paul Schroeppel, MD Scott Mullen, MD Bryan Vopat, MD

Disclosures No conflicts of interest to disclose

Background • Lisfranc injuries are injuries to the tarsometatarsal joints of the midfoot • Disruption of the tarsometatarsal joints by purely ligamentous, purely osseous, or a combination • 0.2% of all fractures with an overall incidence of 1 in 55,000 • Direct and indirect forces, high energy trauma, sporting injuries, and low energy trauma. -Desmond et al., Foot Ankle Int. 2006 -Eleftheriou et al., Knee Surg Sports Traumatol Arthrosc. 2013 -Welck et al., Injury. 2015

Background • For frank instability (>2mm of diastasis) operative outcomes are better than nonop • Variability in the optimal treatment exists between primary reduction and fixation versus primary arthrodesis • Some studies have found that primary arthrodesis may result in better clinical outcomes for certain injuries (purely ligamentous). -Brinsden et al., J R Nav Med Serv. 2001 -Sheibani-Rad et al., Orthopedics. 2012

Purpose • Retrospectively compare primary ORIF vs arthrodesis for Lisfranc injuries: – Cost – Complication Rate – Hardware Removal Rate

Methods • PearlDiver data mining software—Humana database • Treatment Groups: primary non-operative, reduction and fixation, or arthrodesis • Treatment cost analysis • Sub-groups: – Patients with at least one complication after initial treatment – Subsequent hardware removal – Revision Fusion

Results

Discussion • Primary arthrodesis is associated with higher cost • Primary arthrodesis has a higher complication rate (due to patient selection?) • ORIF results in a low rate of progression to arthrodesis • ORIF has a higher rate of hardware removal, which may represent a planned second procedure

Limitations • Retrospective database study, relying on accurate provider ICD and CPT coding • No clinical patient outcomes for each treatment (only cost and complication rate) • Lack of long-term follow up (> 10 years) to determine if more went on to fusion

Conclusion • ORIF may be warranted in a substantial percent of patients presenting with acute Lisfranc injuries due to the lower complication rate and cost • A substantial number of these will require hardware removal • Patient selection remains important in determining optimal surgical treatment for Lisfranc injuries.

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