A Comparison of Complications and Reoperations Between Open Reduction and Internal Fixation Versus Primary Arthrodesis Following Lisfranc Injury.

There is a lack of consensus in the literature regarding optimal treatment methods for Lisfranc injuries, and recent literature has emphasized the need to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA). The purpose of the current study is to compare reoperation and complication rates between ORIF and PA following Lisfranc injury in a private, outpatient, orthopaedic practice. A retrospective chart review was performed on patients undergoing operative intervention for Lisfranc injury between January 2009 and September 2015. A total of 196 patients met the inclusion criteria (130 ORIF, 66 PA), with a mean follow-up of 61.3 and 81.7 weeks, respectively. The ORIF group had a higher reoperation rate than the PA group, due to hardware removal. When hardware removals were excluded, the reoperation rate was similar. Postsurgical complications were compared between the 2 groups with no significant difference. In conclusion, ORIF and PA had similar complication rates. When hardware removals were excluded, the reoperation rates were similar, although hardware removals were more common in the ORIF group compared with the PA group.Levels of Evidence: Level III.

Large Osseous Defect Reconstruction Using a Custom Three-Dimensional Printed Titanium Truss Implant.

Treatment of large osseous defects remains a difficult surgical challenge. Autografts and allografts have been known to undergo late collapse, because these options are not specifically designed to withstand the high loads of the foot and ankle. The inability to achieve the correct shape for reconstruction further limits their application. Large osseous defects will result during salvage after failed Lapidus bunionectomy, explantation of failed total ankle replacements, and nonunion of Evans calcaneal osteotomy. Each of 3 patients received a 4WEB custom 3-dimensional (3D) titanium truss implant (Patient Specific Custom Implant; 4WEB Medical, Inc., Frisco, TX) for reconstruction. The mean follow-up period was 17.33 ± 3.51 months. Significant improvement was seen in pain, with a successful return to activities of daily living. The 12-month postoperative computed tomography findings demonstrated incorporation of the implant to the surrounding cortical and cancellous bone. No signs of delayed complications, such as stress shielding or implant failure, were found. This is the first case series to describe the use of a custom 3D-printed titanium truss implant to successfully contribute to reconstruction in the setting of failed elective foot and ankle surgery. This technology might play an important role in limb salvage of osseous defects that would otherwise require bone block arthrodesis with structural allograft or autograft bone.