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

Cost Comparison and Complication Rate

• f 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)
• perative 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

• utcomes 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.

Questions ?