Treatment of primarily ligamentous XXXX : primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study.

@entity1 @entity571 @entity158 @entity85 @entity130
BACKGROUND: Open reduction and internal fixation is currently the accepted treatment for displaced @entity130 . However, even with anatomic reduction and stable internal fixation, treatment of these injuries does not have uniformly excellent outcomes. The objective of this study was to compare primary arthrodesis with open reduction and internal fixation for the treatment of primarily ligamentous @entity130 . METHODS: Forty-one @entity1 with an isolated acute or subacute primarily ligamentous @entity130 were enrolled in a prospective, randomized clinical trial comparing primary arthrodesis with traditional open reduction and internal fixation. The @entity1 were followed for an average of 42.5 months. Evaluation was performed with clinical examination, radiography, the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, a visual analog @entity158 scale, and a clinical questionnaire. RESULTS: Twenty @entity1 were treated with open reduction and screw fixation, and twenty-one @entity1 were treated with primary arthrodesis of the medial two or three rays. Anatomic initial reduction was obtained in eighteen of the twenty @entity1 in the open-reduction group and twenty of the twenty-one in the arthrodesis group. At two years postoperatively, the mean AOFAS Midfoot score was 68.6 points in the open-reduction group and 88 points in the arthrodesis group (p < 0.005). Five @entity1 in the open-reduction group had persistent @entity158 with the development of @entity85 or @entity571 , and they were eventually treated with arthrodesis. The @entity1 who had been treated with a primary arthrodesis estimated that their postoperative level of activities was 92% of their preinjury level, whereas the open-reduction group estimated that their postoperative level was only 65% of their preoperative level (p < 0.005). CONCLUSIONS: A primary stable arthrodesis of the medial two or three rays appears to have a better short and medium-term outcome than open reduction and internal fixation of ligamentous @entity130 .
