Kecioren Education and Research Hospital, Ankara, Turkey.
Foot Ankle Surg. 2013 Sep;19(3):188-93. doi: 10.1016/j.fas.2013.04.003. Epub 2013 May 11.
Lisfranc fracture dislocations cause severe tarso-metatarsal malalignment. The research question of this study was to evaluate the severity of the soft tissue injury on the final clinical outcome and compare that with the effect of various determinants on the disability in daily living activities after open reduction and internal fixation of a Lisfranc injury.
This study consisted of a retrospective analysis of patients with Lisfranc fracture dislocations who were treated by open reduction and internal fixation beween 2004 and 2009. Evaluation focused mainly on the severity of the soft tissue injury, age, fracture classification, time to operation, posttraumatic osteoarthritis, and the results were compared with American Foot and Ankle Society (AOFAS) scores, and Foot and Ankle Disability Index (FADI). Eight patients had Tscherne Grade 1, 13 had Grade 2, and 11 had Grade 3 soft tissue injuries. Myerson classification revealed 11 type A, 8 type B and 13 type C fractures. Six patients' operations were delayed beyond 8h.
Of the 38 patients treated in the study period, 32 patients (11 female, 21 male; <30 y-old: 14, >30 y-old: 18) were available for complete follow-up (average, 55.5 months). The comparison of treatment results revealed that those patients with high grade soft tissue injuries had lower AOFAS and FADI scores (43.8±15.9, 53.7±9.4, respectively) when compared to Tscherne Grade 1 injuries (82.8±6.1, 109±13.9, respectively) (p<0.001). The overall negative impact of the severity of soft tissue injury on functional outcomes had similar significance with regard to post-traumatic osteoarthritis, and fracture type. There was also a statistically significant difference between outcome measures and post-reduction quality (p=0.002). Patient age (p=0.9) and delayed surgery (p=0.5) had no statistically significant effect on the final outcome.
Satisfactory results can be achieved with open reduction for Lisfranc injuries. However, despite this treatment, both the severity of the soft tissue injury and non-anatomic reduction are negative prognostic factors in the treatment of Lisfranc fracture dislocations.
跖跗关节骨折脱位会导致严重的跗跖骨对线不良。本研究的研究问题是评估软组织损伤的严重程度对最终临床结果的影响，并将其与各种决定因素对 Lisfranc 损伤切开复位内固定后日常生活活动能力障碍的影响进行比较。
本研究回顾性分析了 2004 年至 2009 年间接受切开复位内固定治疗的跖跗关节骨折脱位患者。评估主要集中在软组织损伤的严重程度、年龄、骨折分类、手术时间、创伤后骨关节炎，以及与美国足踝外科协会（AOFAS）评分和足踝残疾指数（FADI）的比较。8 例患者为 Tscherne 1 级，13 例为 2 级，11 例为 3 级软组织损伤。Myerson 分类显示 11 例 A 型，8 例 B 型，13 例 C 型骨折。6 例患者的手术时间超过 8 小时。
在研究期间接受治疗的 38 例患者中，32 例（女性 11 例，男性 21 例；<30 岁 14 例，>30 岁 18 例）可进行完整随访（平均随访 55.5 个月）。治疗结果比较发现，与 Tscherne 1 级损伤相比，高等级软组织损伤患者的 AOFAS 和 FADI 评分较低（分别为 43.8±15.9、53.7±9.4）（p<0.001）。软组织损伤严重程度对功能结果的整体负面影响与创伤后骨关节炎和骨折类型具有相似的意义。在术后复位质量方面，结果测量也存在统计学差异（p=0.002）。患者年龄（p=0.9）和手术延迟（p=0.5）对最终结果无统计学影响。
切开复位治疗跖跗关节损伤可获得满意的效果。然而，尽管进行了这种治疗，软组织损伤的严重程度和非解剖复位都是跖跗关节骨折脱位治疗的负面预后因素。
