Orthostatic Hypotension Leads to Fall and Lisfranc Dislocation/Fracture


71 yo nurse falls at home after neck surgery. …. The most heart warming debate out there….ORIF vs Arthrodesis for Lisfranc injuries – both ligamentous, and osseous/ligamentous combined.

In my mind, patients have the last say as long as it’s reasonable.

The most important feature of the TMT complex is stability, not motion. Arthrodesis provides that, especially in patients where demand requires it. Counterintuitively active patients need this the most. Shannon Rush hammers that point. This particular patient hikes with spouse, was about to retire, and wanted the closest thing to a guarantee of 1 procedure allowing success that could be provided.

Trauma to the TMT complex inherently changes the articulation permanently, true. The advantages arthrodesis affords vs ORIF;

  • 1 procedure assuming union
  • Superior stability
  • No risk of re-injury to ligament that doesn’t exist
  • Decreased risk of complications due to statistically less surgeries required
  • Patients have been shown to reach pre injury activity levels up to 30% better in arthrodesis group
  • Improved pain scores

Literature defines arthrodesis patients as partial vs total.
Partial = 1-3 TMT fusion
Total = 1-5 TMT fusion

Coetzee’s study is really still the best study because he compares his own patients, fusion vs ORIF, with a 3.5 yr follow up. Of course the limitation to his study is follow up time. If the ORIF group is followed for 20 yrs we would presumably see 100% post traumatic OA in the ORIF group.

Counterpoint would be prevalence of adjacent joint arthritis in arthrodesis group.

My argument to that is – does a joint that does not have exceptional motion to begin with place much burden on an adjacent joint, post fusion?

Yes – ORIF’s are quick, and easy, but do they last?

In our own patients, the arthrodesis patients are happier than the open and perc ORIF patients.

This case was fixated with Extremity Medicals IO Fix device which affords incredible compression with intramedullary fixation.

NOTE: Post-op images demonstrate union at 10th week visit.