Feng Pin, Li Ya-Xing, Li Jia, Ouyang Xiang-Yu, Deng Wei, Chen Yu, Zhang Hui
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2017 Feb;9(1):54-61. doi: 10.1111/os.12320.
Lisfranc joint injury is a rare injury and can be easily missed at the initial treatment. Once ignored, late reduction is very difficult and requires extensive dissection. Surgical outcome is not as good as in the case of an early reduction. The aim of this cohort study was to analyze the midterm clinical and radiographic outcomes of staged reduction and fixation in a consecutive series of patients with old Lisfranc injuries.
Fifteen patients (16 feet) with missed Lisfranc injuries were treated with staged reduction. Mean duration between injury and surgery was 4.8 months (3-8 months). In the first stage, an external fixator was applied across the Lisfranc joint or/and Chopart joint and distraction was done at 1-2 mm/day. In the second staged, open reduction and internal fixation (ORIF) were done and we were able to reduce all the fractures and dislocations.
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 point, 7 feet had good functional results, 5 feet fair, and 4 feet poor functional results. In the 4 patients who achieved poor functional results, 2 cases were due to severe injuries to the articular surface and tissue scaring; 2 cases were due to loss of reduction. For the 4 feet with poor functional results, 2 were scheduled for secondary arthrodesis during the follow-up. The average American Orthopaedic Foot and Ankle Society Midfoot Scale (AOFAS) scores for these patients were 75.8 points (range, 43-98 points). The pain visual analog scale (VAS) was 3.1 points at the final follow-up.
Our study demonstrated that staged reduction and extra-articular fixation should be considered for old Lisfranc injuries with a good reduction, firm stability, and low risk of intraoperative fracture and soft tissue complications.
Lisfranc关节损伤较为罕见，在初始治疗时容易被漏诊。一旦被忽视，后期复位非常困难，需要广泛的解剖分离。手术效果不如早期复位的情况。本队列研究的目的是分析一系列连续性陈旧性Lisfranc损伤患者分期复位与固定的中期临床和影像学结果。
15例（16足）漏诊的Lisfranc损伤患者接受分期复位治疗。受伤至手术的平均时间为4.8个月（3 - 8个月）。第一阶段，在Lisfranc关节或/和Chopart关节应用外固定架，每天牵引1 - 2毫米。第二阶段，进行切开复位内固定（ORIF），所有骨折和脱位均成功复位。
两次手术之间的平均时间为3.2周（范围2.5 - 4.5周）。15例患者均获得解剖复位。在最后随访时，7足功能结果良好，5足一般，4足功能结果差。在功能结果差的4例患者中，2例是由于关节面严重损伤和组织瘢痕形成；2例是由于复位丢失。对于功能结果差的4足，随访期间2足计划进行二期关节融合术。这些患者的美国矫形足踝协会中足评分（AOFAS）平均为75.8分（范围43 - 98分）。末次随访时疼痛视觉模拟量表（VAS）评分为3.1分。
我们的研究表明，对于陈旧性Lisfranc损伤，分期复位和关节外固定应被考虑，其具有良好的复位效果、牢固稳定性以及较低的术中骨折和软组织并发症风险。
