Balazs George C, Hanley M G, Pavey G J, Rue J-Ph
Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Department of Orthopaedics and Rehabilitation, United States Naval Academy, Naval Health Clinic Annapolis, Annapolis, Maryland, USA.
J R Army Med Corps. 2017 Jun;163(3):215-219. doi: 10.1136/jramc-2016-000681. Epub 2016 Dec 9.
Lisfranc injuries are relatively uncommon midfoot injuries disproportionately affecting young, active males. Previous studies in civilian populations have reported relatively good results with operative treatment. However, treatment results have not been specifically examined in military personnel, who may have higher physical demands than the general population. The purpose of this study was to examine rates of return to military duty following surgical treatment of isolated Lisfranc injuries.
Surgical records and radiographic images from all active duty US military personnel treated for an isolated Lisfranc injury between January 2005 and July 2014 were examined. Demographic information, injury data, surgical details and subsequent return to duty information were recorded. The primary outcome was ability to return to unrestricted military duty following treatment. The secondary outcome was secondary conversion to a midfoot arthrodesis following initial open reduction internal fixation.
Twenty-one patients meeting inclusion criteria were identified. Median patient age was 23 years, and mean follow-up was 43 months. Within this cohort, 14 patients were able to return to military service, while seven required a disability separation from the armed forces. Of the 18 patients who underwent initial fixation, eight were subsequently revised to midfoot arthrodesis for persistent pain.
Military personnel sustaining Lisfranc injuries have high rates of persistent pain and disability, even after optimal initial surgical treatment. Military surgeons should counsel patients on the career-threatening nature of this condition and high rates of secondary procedures.
跖跗关节损伤是相对少见的中足损伤，对年轻、活跃的男性影响尤为明显。以往针对普通人群的研究报告称手术治疗效果相对较好。然而，对于身体需求可能高于普通人群的军事人员，其治疗结果尚未得到专门研究。本研究的目的是探讨孤立性跖跗关节损伤手术治疗后的重返军事岗位率。
对2005年1月至2014年7月期间接受孤立性跖跗关节损伤治疗的所有美国现役军事人员的手术记录和影像学图像进行检查。记录人口统计学信息、损伤数据、手术细节及后续重返岗位信息。主要结局是治疗后恢复无限制军事任务的能力。次要结局是初次切开复位内固定术后二次转换为中足关节融合术。
确定了21例符合纳入标准的患者。患者中位年龄为23岁，平均随访时间为43个月。在该队列中，14例患者能够重返军事服役，而7例需要从武装部队退役。在18例接受初次固定的患者中，8例因持续疼痛随后改为中足关节融合术。
即使经过最佳的初次手术治疗，遭受跖跗关节损伤的军事人员仍有较高的持续疼痛和残疾率。军事外科医生应向患者告知这种疾病对职业生涯的威胁性质以及二次手术的高发生率。
