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OBJECTIVE@#To compare the clinical efficacy of screw and bone plate internal fixation in the treatment of Lisfranc injury.@*METHODS@#The databases of Wanfang, CNKI, Pubmed, EMBASE, VIP, BIOSIS and other databases were retrieved by computer, and the clinical trial literature from January 1, 2000 to August 1, 2021 was retrieved, the methodological quality of the included studies was strictly evaluated and the data were extracted, and the obtained data were meta-analyzed by Revman 5.4 software.@*RESULTS@#Nine randomized controlled trial literature and 10 retrospective cohort studies were included, of which 416 patients in the experimental group were treated with screw internal fixation, and 435 patients in the control group were treated with bone plate internal fixation. Meta-analysis showed that the surgical time of the bone plate internal fixation group was longer than that of the screw internal fixation group [MD=-14.40, 95%CI(-17.21, -11.60), P<0.000 01], the postoperative X-ray anatomical reduction of the bone plate internal fixation group [MD=0.47, 95%CI(0.25, 0.86), P=0.01], the excellent and good rate of postoperative American orthopedic foot and ankle society(AOFAS) foot function score[MD=0.25, 95%CI(0.15, 0.42), P<0.000 01], postoperative AOFAS foot function score [MD=-5.51, 95%CI(-10.10, -0.92), P=0.02] of the bone plate fixation group was better than those of the screw internal fixation group. Two kinds of operation method had no statistical different for postoperative fracture healing time[MD=1.91, 95%CI(-1.36, 5.18), P=0.25], postoperative visual analgue scale(VAS)[MD=0.38, 95%CI(0.09, 0.86), P=0.11], postoperative complications [MD=1.32, 95%CI(0.73, 2.40), P=0.36], the postoperative infection [MD=0.84, 95%CI(0.48, 1.46), P=0.53], the postoperative fracture internal fixation loosening [MD=1.25, 95% CI(0.61, 2.53), P=0.54], the postoperative incidence of traumatic arthritis [MD=1.80, 95%CI(0.83, 3.91), P=0.14].@*CONCLUSION@#Bone plate fixation has better short-term and medium-term results and lower reoperation rate in the treatment of Lisfranc injury, so it is recommended to use bone plate fixation in the treatment of Lisfranc injury.
Subject(s)
Humans , Bone Plates , Retrospective Studies , Fractures, Bone/surgery , Fracture Fixation, Internal/methods , Bone Screws , Treatment Outcome , Postoperative ComplicationsABSTRACT
Objective:To explore the safety, efficacy and preliminary clinical application of the single plantar approach or in combination with the dorsalis pedis approach in the treatment of Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions.Methods:(1) Six fresh cadaveric specimens of adult foot were collected and dissected through the plantar approach in order to determine the skin incision of the plantar approach and the safe area for plate-screw internal fixation, including start-stop points and courses of plantar nerves, blood vessels, tendons and ligaments, followed by plate-screw fixation on the specimens. (2) After feasibility of the plantar approach was confirmed by our anatomical study, it was used to treat the 3 patients who were admitted to Department of Orthopedics, The Third Hospital Affiliated to Southern Medical University between September 2020 and November 2021 for Lisfranc injury with severe necrosis due to dorsalis pedis skin contusion or metatarsal base avulsion fracture. They were 2 males and one female, with an average age of 51 years (from 34 to 68 years). The preliminary clinical efficacy was evaluated in terms of visual analogue scale (VAS), midfoot score of American Orthopaedic Foot and Ankle Surgeons (AOFAS), Maryland score, Kofoed score, fracture healing at the last follow-up and postoperative complications.Results:(1) Regarding the anatomical exposure range, the metatarsal side of the first metatarsal wedge joint was exposed medially and the metatarsal side of the third metatarsal wedge joint was exposed laterally; the peroneus longus tendon, Lisfranc plantar ligament and interosseous ligament were explored. X-ray films after the simulated operation showed satisfactory plate positions. (2) As for the preliminary clinical application, all patients were followed up for 6 to 14 months (mean, 11 months). At the last follow-up, the VAS score ranged from 0 to 1 (mean, 0.5), AOFAS score from 85 to 92 (mean, 89), Maryland score from 93 to 96 (mean, 95), and Kofoed score from 92 to 95 (mean, 94). There were no early complications such as fascial compartment syndrome, skin necrosis or infection. All fractures got united, with no complications like traumatic arthritis, muscle atrophy or screw loosening.Conclusion:Testified by the anatomical study, the plantar approach can be used to treat Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions, leading to safe, effective and satisfactory clinical outcomes.
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Objective:To investigate the mid-term clinical outcomes of selective column arthrodesis based on the three-column theory in the treatment of malunion of Lisfranc injury.Methods:The 28 patients with malunion of Lisfranc injury were analyzed retrospectively who had been treated by selective column arthrodesis at Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine from January 2011 to January 2020.They were 18 males and 10 females, with an average age of 37.2 years(from 18 to 65 years). Twelve left and 16 right sides were affected. According to Myerson's three-column classification, one case was medial column injury (type A), 4 ones middle column injury (type B), 7 ones medial plus middle columns injury and 16 ones three-column injury. Medial column arthrodesis was conducted in 7, middle column arthrodesis in 4 and medial plus middle columns arthrodesis in 17. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and visual analogue scale (VAS) were compared between preoperation and the last follow-up to evaluate the improvements in foot function and pain. The operation-related complications were recorded.Results:All patients were followed up for an average of 35.6 months (from 18 to 60 months). The AOFAS midfoot score increased from 43.1±4.1 at pre-operation to 84.1± 7.4 at the last follow-up and the VAS score decreased from 5.7±1.3 at pre-operation to 2.0±0.9 at the last follow-up (both P<0.001). The wounds healed in 28 patients, 3 of whom had postoperative wound exudation but responded to dressing change. There were no such complications as injury to the deep peroneal nerve or deep venous thrombosis. The internal fixation was removed in 5 patients at about one year after arthrodesis. Conclusion:Selective column arthrodesis based on the three-column theory can result in satisfactory med-term clinical outcomes in the treatment of malunion of Lisfranc injury.
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Objective:To explore the short- and mid-term clinical outcomes of surgical treatment of chronic Lisfranc injuries.Methods:A retrospective analysis was conducted of the clinical and imaging data of the 19 patients with chronic Lisfranc injury who had been treated surgically from April 2013 to September 2020 at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. There were 13 males and 6 females, aged from 25 to 58 years (mean, 49 years). The median course of disease before operation was 24 months (from 3 to 312 months). All patients underwent fusion of the 1st, 2nd and 3rd tarsometatarsal joints (TMTJ) plus reduction and fixation or arthroplasty of the 4th and 5th TMTJ by the same surgeon. The clinical outcomes were evaluated by comparison of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, visual analogue scale (VAS) and Lublin score between pre-operation and the final follow-up and by Likert satisfaction scale and post-operative complications as well.Results:The 19 patients were followed up for (66.1±23.2) months (from 12 to 104 months). At the final follow-up, the AOFAS midfoot score was 87 (79, 90), the VAS score 1 (0, 2), and the Lublin score 70 (60, 75), all significantly improved compared with their preoperative corresponding values [51 (44, 63), 4 (4, 6) and 50 (40, 55), respectively] ( P<0.05). Sixteen patients were satisfied with their surgery. Fusion was not healed in 3 cases; plate breakage happened in one case but none of the cases had infection or other complications related to the skin or wound. Conclusion:Fusion of the 1st, 2nd and 3rd TMTJ plus reduction and fixation or arthroplasty of the 4th and 5th TMTJ can lead to good short- and mid-term clinical outcomes in the surgical treatment of chronic Lisfranc injuries.
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Objective:To investigate the outcomes of the surgical treatment of fracture of the first metatarsal base with plantar plate via the first metatarsal medial approach.Methods:A retrospective study was conducted of the 12 patients who had been treated for fracture of the first metatarsal base from January 2016 to December 2018 at Department of Trauma Orthopaedics, Renji Hospital. They were 8 men and 4 women, with an average age of 39.6 years (from 27 to 54 years). The fracture affected the left foot in 5 cases and the right foot in 7. Their fracture of the first metatarsal base and tarsometatarsal joint instability were fixated by plantar plate via the first metatarsal medial approach, and reduction and fixation was also conducted via a dorsal incision when other metatarsotarsal joint injuries were combined. Postoperative X-ray follow-ups were performed regularly. The American Orthopedic Foot and Ankle Society (AOFAS) midfoot scores, visual analogue scale (VAS) pain scores and complications were recorded at the final follow-up.Results:All the patients were followed up for 12 to 19 months (mean, 15.1 months). Primary incision healing was observed in all the 12 patients. No complications like skin necrosis, infection or neurovascular lesion occurred. Fracture union was achieved in all the 12 patients after 12 to 14 weeks (average, 12.6 weeks). At the final follow-up, all the patients could walk with full weight-bearing, the plantar flexion and dorsiflexion of the ankle and the muscle strengths of varus and valgus were normal, and the X-ray film showed that reduction of the tarsometatarsal joint was not lost. At the final follow-up, the AOFAS midoot scores ranged from 82 to 96 (mean, 88.9) and the VAS scores from 0 to 3 (mean, 1.2).Conclusion:Plantar plate fixation via the first metatarsal medial approach can result in satisfactory outcomes for fractures of the first metatarsal base, especially for those with a major fracture fragment at the metatarsal planter side.
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An isolated dislocation of the intermediate cuneiform bone is a rare midfoot injury. This paper reports a case of a 60 year old man who fell from a height with his foot in the plantar flexed position. An isolated dorsal dislocation of the intermediated cuneiform was confirmed. Good results were obtained after an open reduction and internal fixation with a Lisfranc screw and Kirschner wire.
Subject(s)
Joint Dislocations , Foot , Tarsal BonesABSTRACT
Objective: To evaluate the effectiveness of open reduction and internal fixation (ORIF) in treatment of acute and delayed occult Lisfranc injuries. Methods: A retrospective review of 26 patients with occult Lisfranc injuries who were treated with ORIF between July 2010 and July 2015 was applied. Fourteen patients were treated within 6 weeks after injury (acute group) and 12 patients were treated after 6 weeks of injury (delayed group). There was no significant difference between the two groups in gender, age, affected sides, and preoperative visual analogue scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) score, and physical and mental scores of Study Short Form 12 Health Survey (SF-12) ( P0.05). The satisfaction rates were 100% and 83.3% (10/12) in acute group and delayed group, respectively. The internal fixators were removed in 20 patients (11 cases in acute group and 9 cases in delayed group) at 9-24 months after operation (mean, 14.5 months). The results of X-ray films showed no traumatic osteoarthritis, midfoot collapse, internal fixation failure, or reduction loss during follow-up period. Conclusion: ORIF is an ideal method for both acute and delayed occult Lisfranc injuries and can obtain the similar effectiveness.
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Objective To analyze the related risk factors for Lisfranc injury resulting from low energy violence.Methods A retrospective study was performed for 61 cases (35 males,26 females) with low-energy foot injury hospitalized from June 2008 to June 2014.Mean age was 36.7 years (range,16-57 years).Fall injuries were noted in 24 cases,sports injuries in 21 cases,and twist injuries in 16 cases.The cases were divided into Lisfranc injury group(n =23) and non-Lisfranc injury group (n =38) according to the different diagnosis.Univariate analysis and multi-factor logistic regression analysis were used to identify the factors that may lead to the occurrence of Lisfranc injury including age,gender,body mass index,operation history,smoking,alcohol abuse,injury reason,medial depth of the mortise/ second metatarsal length (b/a),lateral depth of the mortise/ second metatarsal length (c/a),first metatarsal-to-talus angle,first intermetatarsal angle,second metatarsal length/foot length(a/g),calcaneal inclination angle and cuboid-navicular overlap/cuboid vertical height (e/e + f).Results Univariate analysis showed between-group differences were significant in age (x2 =7.385,P ＜0.05),injury reason (x2 =8.663,P ＜ 0.05),calcaneal inclination angle (t =3.958,P ＜ 0.05),b/a (t =5.051,P ＜ 0.05) and a/g(t =4.618,P ＜ 0.05).Logistic regression analysis identified b/a(OR =1.036,95 ％ CI 0.018-0.450,P ＜ 0.01) and a/g(OR =1.013,95％ CI 0.005-0.374,P ＜ 0.01) as independent risk factors for low-energy Lisfranc injury.Conclusion Low-energy Lisfranc injury is independently associated with b/a and a/g,and may relate to the decreased medial depth of the mortise and increased foot length.
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Objective To analyze the clinical and radiographic outcomes of staged reduction and fixation in a consecutive series of patients with the old Lisfranc injuries. Methods Fifty patients (16 feet) with Lisfranc injuries were treated with staged reduction. Mean duration between injury and surgery was 4. 8month ( 3 to 8 month) . In first stage an external fixator was applied across the Lisfranc joint and distraction was done at 1 milliliter per day to 2 milliliter per day. In the second staged the ORIF ( open reduction and internal fixation) was doneand we were able to reduce all the fractures and dislocations. Extra-Articular screws and staple fixation were used for fixation. We compared categorical variables using Fisher’ s exact test and continuous variables using paired t-test or Wilcoxon signed-rank test. Results All patients were followed up 1 to 3 years ( mean 2. 2 years) in the clinic. The visual analogue scale score averaged 3. 1 points at the final follow-up, the average AOFAS scores for these patients were 55. 8 points ( range, 43 to 98 points), with a significant increase than before surgery ( P=0. 001). The mean duration between two surgeries was 3. 2 weeks (range 2. 5-4. 5 weeks). Anatomic reduction was obtained in all 15 patients. At the last follow-up, 2 patients had lost reduction. Posttraumatic osteoarthritis was observed in 5 patients, and all of them were scheduled for arthrodesis because of persistent pain. Conclusions The study have displayed that staged reduction and Extra-Articular fixation should be considered for old Lisfranc injuries with a good reduction, the firm stability, low risk of intraoperative fracture. The short-term effectiveness is good, but the long-term effectiveness needs further follow-up.
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The Lisfranc joint complex is an anatomical association of many bones and articulation, restrained by an even more complex network of ligaments, capsules, and fascia, which must work in concert to provide normal and painless motion. Careful diagnostic workup with high-quality radiographs and computed tomography of the foot are used to diagnose injuries and fractures of this complex. We have to understand the normal anatomy and injury mechanism in order to appropriately treat Lisfranc injuries. Good results have been associated with anatomic reductions of all bones, which was achieved with restoration of proper alignment.
Subject(s)
Capsules , Fascia , Foot , Joints , LigamentsABSTRACT
Lisfranc injury is complex and difficult to treat. Making the correct diagnosis and achieving an anatomical reduction are important factors in regard to achieving a favorable outcome with this injury. We describe a new technique that we have found to be useful for stabilizing Lisfranc injury. This method is relatively fast and simple, and it provides non-rigid fixation. Also, it eliminates the need for implant removal. To date, we have achieved predictable results for stabilizing and treating this injury with the use of a TightRope(TM) Device, instead of traditional interfragmental screw fixation. In this report, we describe a case in which this method was used with satisfactory short-term results.