Fracturas de la base del quinto metatarsiano: ¿es útil mi tornillo de esponjosa con rosca parcial? Experiencia de 10 años / Fractures of the base of the fifth metatarsal bone: is my partially-threaded cancellous screw useful? 10-year experience

OBJETIVO Evaluar el resultado quirúrgico de fracturas de las zonas 2 y 3 de la base del quinto metatarsiano usando tornillos de esponjosa de diámetro de 4,0 mm con rosca parcial. MATERIALES Y MÉTODOS Evaluación retrospectiva de pacientes operados entre 2010 a 2019. Incluimos todos los casos sintetizados con este dispositivo con seguimiento mínimo de tresmeses, y excluimos casos operados con otros dispositivos y seguimiento menor a tres meses. Evaluamos la consolidació n y la presencia de complicaciones. Determinamos el largo del tornillo, el diámetro del canal endomedular, la distancia entre el borde proximal de la tuberosidad y la fractura, y la distancia de paso de la rosca sobre el rasgo de la fractura en radiografías anteroposterior (AP) y oblicua del pie. RESULTADOS Evaluamos 39 casos, y la muestra tenía una edad promedio de 27 años, y predominio del sexo masculino. El largo de tornillo más usado fue el de 45 mm, y los diámetros promedios del canal endomedular medidos en las radiografías AP y oblicua fueron de 4,6 mm y 3,96 mm, respectivamente. La distancia del borde de la tuberosidad hasta la fractura fue de 25,8 mm, y la distancia de paso de la rosca sobre el rasgo de la fractura fue en promedio de 24 mm. Hubo 100% de consolidación, en un promedio de 9,4 semanas, y 3 casos de retardo de consolidación, 2 de retroceso de tornillo, 1 de rosca intrafoco, y 1 de fractura cortical superior. No hubo retiros de tornillos a la fecha. DISCUSION No existe consenso respecto al tornillo ideal. La literatura internacional recomienda dispositivos intramedulares de diámetro de al menos 4,5 mm. Existen pocos reportes del uso de tornillos de diámetro de 4,0 mm. CONCLUSIONES El tornillo de esponjosa de diámetro de 4,0 mm con rosca parcial es una alternativa eficaz, segura y con baja tasa de complicaciones para el manejo de estas fracturas en nuestra población.

OBJETIVE To evaluate the surgical result of zone-2 and -3 fractures of the base of the fifth metatarsal bone using partially-threaded cancellous screws with a diameter of 4.0 mm. MATERIALS AND METHODS A retrospective evaluation of patients submitted to surgery between 2010 and 2019. We included all of the cases synthesized with this device with a minimum follow-up of three months, and excluded the cases operated on with other devices and follow-up shorter than three months. We evaluated the consolidation and the presence of complications, and determined, screw length, diameter of the endomedullary canal, the distance between the proximal edge of tuberosity and the fracture, and thread pitch over the fracture line on anteroposterior (AP) and oblique radiographs. RESULTS We evaluated 39 cases, and the sample had an average age of 27 years and male predominance. The most used screw length was 45 mm, and the average diameters of the medullary canal measured on the AP and oblique radiographs were of 4.6 mm and 3.96 mm respectively. The distance from the edge of the tuberosity to the fracture was of 25.8 mm, and the thread pitch over the fracture line was on average 24 mm. The rate of consolidation was of 100%, occurring in an average of 9.4 weeks, and there were 3 cases of consolidation delay, 2 of screw recoil, 1 of intrafocus thread, and 1 of superior cortex fracture. To date, there have been no cases of screw removal. DISCUSSION There is no consensus regarding the ideal screw. The international literature recommends intramedullary devices with a diameter of at least 4.5 mm. There are few reports of the use of screws with 4.0 mm in diameter. CONCLUSIONS The partially-threaded cancellous screw with a diameter of 4.0 mm is an effective and safe option, with a low complication rate for the management of these fractures.

Selective column arthrodesis based on three-column theory for malunion of Lisfranc injury / 中华创伤骨科杂志

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.

Manifestations of different imaging methods of Lisfranc joint injury and their clinical significance / 中国基层医药

Objective:To investigate the manifestations of different imaging methods of Lisfranc joint injury and their classification, providing a theoretical basis for increasing the rate of diagnosis of Lisfranc joint injury.Methods:The clinical data of 238 patients with Lisfranc joint injury who received treatment in the First People's Hospital of Wenling from January 2017 to January 2020 were retrospectively analyzed. According to the different types of injury, the clinical data were classified into Myerson and Nunley-Vertullo types and then statistically analyzed. The features of X-ray, CT and MRI images of injured Lisfranc joint were observed.Results:Among the 238 patients, 175 had Lisfranc joint fracture and dislocation, with Myerson classification type I 18 patients, type II 149 patients, and type III 8 patients; 63 had Lisfranc joint injury or sprain, with Nunley-Vertullo classification type I 14 patients, type II 45 patients and type III 4 patients. Only X-ray examination was performed in 8 patients, only CT scan in 10 patients, and only MRI in 17 patients. Both X-ray examination and CT scan were performed in 172 patients, both X-ray examination and MRI in 13 patients, both CT scan and MRI in 13 patients, and all X-ray examination, CT scan and MRI in 5 patients. The correct rate of the first X-ray diagnosis was 85.35% (169/198). In 157 patients with Myerson-type Lisfranc joint injury, the correct rate of diagnosis was 92.36% (145/157). In 41 patients with Nunley-Vertullo-type Lisfranc joint injury, the correct rate of diagnosis was 65.85% (27/41). There was significant difference in the correct rate of diagnosis between Myerson-type and Nunley-Vertullo-type Lisfranc joint injury ( χ2 = 5.135, P = 0.024). CT scan examination invovled the basal part of M2 in 88.50% (177/200) of patients, the basal part of M2-M4 in 64.00% (128/200) of patients, and the lateral dislocation of M2 in 65.00% (130/200) of patients . Three-dimensional reconstructions revealed that 37.00% (74/200) of patients had dorsal dislocation or subluxation and 7.50% (14/200) of patients had metatarsal dislocation or subluxation. MRI examination revealed that six patients had grade I injury, showing abnormal but uninterrupted signal, 24 patients had grade II injury, showing partial rupture of ligament, and 18 patients had grade III injury, showing complete rupture of ligament (interrupted or absent ligament signal). Conclusion:Among the different imaging diagnostic methods of Lisfranc joint injury, X-ray examination may lead to missed diagnosis. For patients with highly suspected Lisfranc joint injury who are not confirmed to suffer from Lisfranc joint injury by X-ray examination, CT scan or MRI should be performed.

Tarsal Navicular Fracture in a Parkour Practitioner, a Rare Injury - Case Report and Literature Review / Fratura do escafoide társico em um praticante de parkour, uma lesão rara - Relato de Caso e Revisão da Literatura

Abstract Tarsal navicular fractures, as well as other midfoot injuries, are rare, and can result in severe impairment if not properly treated. Parkour, a modern sport, is gaining popularity among young individuals in urban areas, and is prone to result in high-energy trauma, which is scarcely described in the literature. The following is a report of a rare case of tarsal navicular fracture in a 17-year-old male, sustained during parkour practice, which was treated successfully with open reduction and internal fixation. The description of the case emphasizes the challenges of its approach; the discussion highlights the treatment options and goals. The case should also raise awareness about the increasing occurrence of these uncommon lesions.

Resumo As fraturas do escafoide társico, bem como outras lesões do médiopé, são raras e podem resultar em incapacidade grave se não forem tratadas adequadamente. Parkour, um esporte moderno, está ganhando popularidade entre os jovens em áreas urbanas, e é propenso a traumatismos de alta energia, sendo estes escassamente descritos na literatura. O presente relato trata de um caso de fratura rara do escafoide társico em um paciente do sexo masculino de 17 anos, ocorrida durante a prática de parkour, que foi tratada com sucesso, com redução aberta e fixação interna. A descrição do caso enfatiza os desafios na sua abordagem; a discussão destaca as opções de tratamento e seus objetivos. O caso também deve alertar sobre a ocorrência crescente dessas lesões incomuns.

EPIDEMIOLOGICAL STUDY ON LISFRANC INJURIES / ESTUDO EPIDEMIOLÓGICO DAS LESÕES DE LISFRANC

ABSTRACT Objective: To analyze the characteristics of patients with Lisfranc injuries and their associated fractures . Methods: This is a retrospective analysis on 42 patients with Lisfranc injuries hospitalized at Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, between 2006 and 2010. Parameters on patient profile, risk factors, fracture characteristics, data on treatment and acute complications were analyzed . Results: Analysis of 42 cases showed that in our sample, men were more affected than women, with a ratio of 4.25:1. The most frequent trauma mechanism was car accident, followed by motorcycle accident. The most frequent type of injury was isolated lesion type B of Quenu and Kuss classification, representing 50% of cases. The most common fracture on the sample was the second metatarsal bone, with 16 cases, followed by cuboid bone fracture. Among the 42 cases, 17% had exposed fractures and 33 patients presented other associated fractures. The mean time elapsed between the trauma and definitive treatment was 6.7 days, while the mean length of hospital stay was 13.8 days. Six patients presented acute postoperative complications . Conclusion: Lisfranc injuries are more common in men undergoing automobile trauma. The prevalence of associated fractures is a frequent finding and the hospital stay may be longstanding. Level of Evidence IV, Case Series.

RESUMO Objetivo: Analisar o perfil de pacientes com lesões de Lisfranc, as características das lesões e fraturas associadas. Métodos: Trata-se de uma análise retrospectiva com 42 pacientes com lesões de Lisfranc internados no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 2006 e 2010. O perfil dos pacientes, características das lesões, fraturas associadas, dados sobre o tratamento e complicações agudas foram analisados. Resultados: Nesta amostra, os homens foram mais afetados do que as mulheres, com uma proporção de 4,25:1. O mecanismo de trauma mais frequente foi acidente de carro, seguido por acidente com moto. O tipo de lesão mais frequente foi a lesão isolada tipo B de Quenu e Kuss, representando 50% dos casos. A fratura mais comumente encontrada foi a do segundo metatarso, com 16 casos, seguido pela fratura do osso cubóide. Entre os 42 casos estudados, sete foram fraturas expostas e 33 pacientes apresentaram fraturas associadas. O tempo médio entre o trauma e o tratamento definitivo foi de 6,7 dias. O tempo médio de permanência hospitalar foi de 13,8. Seis pacientes apresentaram complicações pós-operatórias agudas. Conclusão: As lesões de Lisfranc são mais comuns em homens submetidos a trauma automobilístico. A prevalência de fraturas associadas é um achado frequente e o tempo de permanência hospitalar pode ser prolongado. Nível de Evidência IV, Série de Casos:

Fracture and Dislocation of the Midtarsal Joint: A Case Report / 대한족부족관절학회지

The midtarsal joint is composed of the talonavicular and calcaneocuboid joints. It is also known as the Chopart joint. Midtarsal joint fracture and dislocation are relatively rare and frequently missed or misdiagnosed. A proper understanding about the anatomy of the midtarsal joint is an essential part in comprehending the mechanism of injury and rationale for treatment. Anatomical reduction of midtarsal joint with correction of the column in length and shape are important; however, it is technically challenging and may require open procedure. Herein, we described a case of initial open reduction and internal fixation for midtarsal joint fracture and dislocation with a brief literature review.

Outcome comparison of lisfranc injuries treated through dorsal plate fixation versus screw fixation

O objetivo deste estudo prospectivo foi testar se o tratamentode lesões de Lisfranc com redução aberta e fixação da placadorsal teria os mesmos resultados funcionais, ou melhores, do quetratamento padrão com fixação com parafuso transarticular. Métodos:Sessenta pacientes com lesão articular de Lisfranc foram tratadospor redução aberta e fixação da placa dorsal ou pelo método padrãopor fixação de parafusos. Os pacientes foram acompanhados por,em média, 31 meses. A avaliação foi realizada com base na queixaprincipal dos pacientes, exame clínico, radiografia, e escala AOFAS.Resultados: Trinta e dois pacientes foram tratados com redução abertae fixação da placa dorsal, e vinte e oito pacientes foram tratadoscom redução aberta e fixação com parafuso. Depois de dois anos deacompanhamento, a média do escore AOFAS foi de 83,1 pontos nogrupo de fixação da placa dorsal e 78,5 pontos no grupo de fixaçãocom parafusos (p <0,01). Do grupo de fixação com placa dorsal, aanálise radiográfica revelou redução anatômica em vinte e nove pacientes(90,6%, 29/32) e redução não anatômica em três pacientes.Do grupo de fixação com parafuso, a análise radiográfica revelou reduçãoanatômica em vinte e três pacientes e redução não anatômicaem cinco pacientes (82,1%, 23/28). Conclusões: A redução abertae fixação com placa dorsal para lesão de Lisfranc deslocada têmmelhor resultado a curto e médio prazo e uma taxa de reoperaçãoinferior do que a técnica padrão de redução aberta e fixação interna(RAFI) com parafuso. Em nossa experiência, recomendamos o usode placa dorsal em RAFI nas lesões de Lisfranc deslocadas. Nívelde Evidência II, Estudo Prospectivo Comparativo...

The objective of this prospective study was to testwhether the treatment of Lisfranc injuries with open reductionand dorsal plate fixation would have the same or better functionaloutcomes as treatment with standard trans-articular screwfixation. Methods: Sixty patients with primarily isolated Lisfrancjoint injury were treated by open reduction and dorsal platefixation or standard screw fixation. The patients were followedon average for 31 months. Evaluation was performed with patients’chief complaint, clinical examination, radiography, andAOFAS Midfoot Scale. Results: Thirty two patients were treatedwith open reduction and dorsal plate fixation, and twenty eightpatients were treated with open reduction and screw fixation.After two years follow-up, the mean AOFAS Midfoot score was83.1 points in the dorsal plate fixation group and 78.5 points inthe screw fixation group (p<0.01). Of the dorsal plate fixationgroup, radiographic analysis revealed anatomic reduction intwenty-nine patients (90.6%, 29/32) and nonanatomic reductionin three patients. Of the screw fixation group, radiographicanalysis revealed anatomic reduction in twenty-three patientsand nonanatomic reduction in five patients (82.1%, 23/28).Conclusions: Open reduction and dorsal plate fixation for adislocated Lisfranc injury do have better short and median termoutcome and a lower reoperation rate than standard screw ORIF.In our experience, we recommend using dorsal plate in ORIF ondislocated Lisfranc injuries. Level of Evidence II, ProspectiveComparative Study...

Evaluation of midfoot function after subtalar arthrodesis / 中华骨科杂志

Objective To evaluate the influence of simple subtalar arthrodesis to the motion and degeneration of midfoot.Methods Data of 37 patients (27 males,10 females) with an average age of 42.6 years who had undergone subtalar joint fusion from January 1996 to August 2011 were retrospectively analyzed.The MOS item short form health survey (SF-36),American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score were used.Midfoot sagittal and coronal motion were measured on ankle radiographs of maximum plantar flexion and dorsiflexion.On sagittal plane,the Meary angle was measured and the bilateral tarsometatarsal joints mobility was compared.On coronal plane,tibio-plantar angles (TPA) on 30 degrees varus slope and 30 degrees valgus slope were respectively measured on the anterio-posterior ankle X-ray films to observe the changes of midfoot activities.Besides,single photon emission computed tomography/computed tomography (SPECT/CT) of bilateral foot and ankle was taken to estimate the degeneration of midfoot joint.Results All the 37 patients were followed-up,with mean follow-up period of 9.2 years.The average SF-36 scores was increased from 34.26± 11.02 points preoperatively to 77.59± 12.57 points postoperatively.The average AOFAS midfoot scores were 86.14± 16.79 points preoperatively and 86.43± 16.70 points postoperatively without any statistical significant difference.On sagittal plane,medial tarsometatarsal joints mobility was limited by 20％.According to coronal plane of varus slope,the average TPA of healthy side and operated side were 61.32° and 64.91°,respectively,so the varus mobility of operated side was limited by 12.5％.While standing on the valgus slope,the average TPA of both sides were 76.54° and 82.28°,which indicated that valgus mobility of operated side was reduced by 42.6％.35.1％ patients of talonavicular joint,56.8％ patients of calcaneocuboid joint,and 27.0％ patients of metatarsal cuboid joint were found mild joint degeneration on SPECT/CT images without any clinical symptoms.Conclusion Subtalar arthrodesis can affect midfoot with less limit of sagittal mobility and more limit of coronal movement.And the lateral joints degeneration is more likely to happen for their compensatory activity.

Avaliação do tratamento cirúrgico da fratura-luxação de Lisfranc / Evaluation of the surgical treatment of Lisfranc joint fracture-dislocation

Estudo retrospectivo de 19 casos de fratura-luxação de Lisfranc tratados cirurgicamente no período de 1995 a 2003. O tempo de acompanhamento foi de 35 meses (variando de 4 a 97 meses). O tratamento cirúrgico foi realizado no dia do trauma em 14 casos, com média de demora de 4,78 horas. Ocorreram 5 lesões expostas (36,32 por cento) e 5 pacientes foram vítimas de politraumatismo. O mecanismo de lesão mais freqüente foi o acidente motociclístico, seguido da queda de animais e de altura. Utilizou-se a avaliação funcional proposta pela AOFAS (The American Orthopaedic Foot And Ankle Society), que apresentou média de 77,53 (variou de 44 a 100). Houve relação entre a qualidade da redução obtida e o resultado do tratamento (p = 0,0449) e entre o fato do pacientes ser vítima de politraumatismo e um resultado inferior do escore AOFAS (p= 0.0143). Houve como complicação a presença de Osteoartrose em 8 casos (42,10 por cento), confirmando-a como a principal complicação radiográfica destas lesões. Sua ocorrência foi analisada comparando-se com a qualidade da redução e com os diferentes tipos de lesão (exposta,lesão ligamentar ou fratura, se lesão isolada ou politraumatismo) não encontrando relação com significância estatística (p < 0,005).

This was a retrospective study of 19 cases of Lisfranc fracture-dislocation surgically treated during the period of 1995 - 2003. The follow-up period was 35 months (range: 4 - 97 months). Surgical treatment was provided on the day of the injury in 14 cases, taking an average of 4.78 hours. There were 5 open injuries (36.32 percent) and 5 patients experienced multiple injuries. The most frequent mechanisms of injury were motorcycle accidents, followed by falls from animals, and high falls. The functional evaluation proposed by AOFAS (The American Orthopaedic Foot and Ankle Society) was employed, which reported an average of 77.53 (ranging from 44 to 100). A correlation was found between the quality of the reduction achieved and treatment outcome (p = 0.0449), and between multiple traumas and poorer AOFAS score results (p = 0.0143). Complications such as osteoarthritis occurred in 8 cases (42.10 percent), confirming this as the main radiographic complication of these injuries. Its incidence was analyzed comparing the quality of the reduction to the different types of injury (open or closed, ligament injury or fracture, isolated injury or multiple injuries) not reporting any statistically significant correlation (p<0.005).