Effectiveness of internal fixation versus arthrodesis on posttraumatic metatarsal-cuneiform joint dislocation: A systematic review and meta-analysis.

BACKGROUND: The metatarsal-cuneiform joint, part of the Lisfranc complex, is essential for midfoot stability, load distribution, and gait mechanics. Injuries, often from high-energy trauma such as traffic accidents or falls, can lead to chronic instability, pain, and functional impairment. Despite accounting for only 0.2% of fractures, Lisfranc injuries are frequently missed in initial diagnosis. Surgical management typically involves internal fixation (IF) to preserve mobility or arthrodesis for permanent stability, yet evidence on their long-term effectiveness remains conflicting, highlighting the need for comparative evaluation. METHODS: A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Scopus, Medline, and Cochrane Library were searched for studies published from January 2015 to June 2025. Ten studies met the inclusion criteria, comprising 441 patients (284 IF, 157 arthrodesis). Primary outcomes were the American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analog Scale (VAS) pain score; secondary outcomes included recovery time and reoperation rate. Data were pooled using mean differences (MD) and percentages with corresponding p-values. RESULTS: Arthrodesis yielded significantly higher AOFAS scores compared with IF (85.40 ± 5.51 vs 83.96 ± 5.67; MD = +1.44; p = 0.001) and lower VAS pain scores (1.31 ± 1.2 vs 2.56 ± 1.5; MD = -1.26; p = 0.038). Mean recovery time was shorter in the arthrodesis group (14.23 ± 4.76 weeks) versus IF (16.34 ± 7.81 weeks; MD = -2.11 weeks; p = 0.042). Reoperation rates were significantly lower with arthrodesis (13% vs 30.48%; p = 0.031). CONCLUSIONS: Arthrodesis offers superior functional recovery, pain relief, faster return to ambulation, and fewer reoperations than IF in posttraumatic Lisfranc injuries. Surgical choice should be individualized - arthrodesis is recommended for severe instability requiring maximal stability, while IF may be appropriate for younger or athletic patients prioritizing joint mobility. LEVEL OF EVIDENCE: Level I, systematic review and meta-analysis.