Renninger Christopher H, Cochran Grant, Tompane Trevor, Bellamy Joseph, Kuhn Kevin
1 Trauma and Foot and Ankle Surgery, Department of Orthopedics, Naval Medical Center San Diego, San Diego, CA, USA.
Foot Ankle Int. 2017 Sep;38(9):964-969. doi: 10.1177/1071100717709575. Epub 2017 Jul 10.
Lisfranc injuries result from high- and low-energy mechanisms though the literature has been more focused on high-energy mechanisms. A comparison of high-energy (HE) and low-energy (LE) injury patterns is lacking. The objective of this study was to report injury patterns in LE Lisfranc joint injuries and compare them to HE injury patterns.
Operative Lisfranc injuries were identified over a 5-year period. Patient demographics, mechanism of injury, injury pattern, associated injuries, missed diagnoses, clinical course, and imaging studies were reviewed and compared. HE mechanism was defined as motor vehicle crash, motorcycle crash, direct crush, and fall from greater than 4 feet and LE mechanism as athletic activity, ground level twisting, or fall from less than 4 feet. Thirty-two HE and 48 LE cases were identified with 19.3 months of average follow-up.
There were no differences in demographics or missed diagnosis frequency (21% HE vs 18% LE). Time to seek care was not significantly different. HE injuries were more likely to have concomitant nonfoot fractures (37% vs 6%), concomitant foot fractures (78% vs 4%), cuboid fractures (31% vs 6%), metatarsal base fractures (84% vs 29%), displaced intra-articular fractures (59% vs 4%), and involvement of all 5 rays (23% vs 6%). LE injuries were more commonly ligamentous (68% vs 16%), with fewer rays involved (2.7 vs 4.1).
LE mechanisms were a more common cause of Lisfranc joint injury in this cohort. These mechanisms generally resulted in an isolated, primarily ligamentous injury sparing the lateral column. Both types had high rates of missed injury that could result in delayed treatment. Differences in injury patterns could help direct future research to optimize treatment algorithms.
Level III, comparative series.
尽管文献更多关注高能量机制，但利斯弗朗关节损伤可由高能量和低能量机制导致。目前缺乏对高能量（HE）和低能量（LE）损伤模式的比较。本研究的目的是报告低能量利斯弗朗关节损伤的损伤模式，并将其与高能量损伤模式进行比较。
在5年期间识别出接受手术治疗的利斯弗朗关节损伤病例。回顾并比较患者的人口统计学资料、损伤机制、损伤模式、相关损伤、漏诊情况、临床病程及影像学检查结果。高能量机制定义为机动车碰撞、摩托车碰撞、直接挤压以及从超过4英尺高处坠落，低能量机制定义为体育活动、地面扭转或从低于4英尺高处坠落。共识别出32例高能量损伤和48例低能量损伤病例，平均随访时间为19.3个月。
在人口统计学资料或漏诊频率方面无差异（高能量损伤组为21%，低能量损伤组为18%）。寻求治疗的时间无显著差异。高能量损伤更可能伴有非足部骨折（37%对6%）、足部骨折（78%对4%）、骰骨骨折（31%对6%）、跖骨基底骨折（84%对29%）、关节内移位骨折（59%对4%）以及累及所有5条射线（23%对6%）。低能量损伤更常见为韧带损伤（68%对16%），累及的射线较少（2.7条对4.1条）。
在该队列中，低能量机制是利斯弗朗关节损伤更常见的原因。这些机制通常导致孤立的、主要为韧带的损伤，不累及外侧柱。两种类型的损伤漏诊率都很高，可能导致治疗延迟。损伤模式的差异有助于指导未来的研究以优化治疗方案。
三级，比较性系列研究。
