Lau Simon, Guest Catherine, Hall Marcus, Tacey Mark, Joseph Samuel, Oppy Andrew
*Department of Orthopaedics, Royal Melbourne Hospital, Victoria, Australia; †Monash University, Victoria, Australia; ‡University of Melbourne, Victoria, Australia; and §Department of Orthopaedics, Frankston Hospital, Victoria, Australia.
J Orthop Trauma. 2017 Aug;31(8):447-452. doi: 10.1097/BOT.0000000000000848.
To identify whether transarticular screws, dorsal bridging plates or a combination of the 2 result in the best functional outcome after Lisfranc injury.
Case series.
Level one trauma center.
Fifty patients who underwent surgical fixation of Lisfranc injuries over a 6-year period were retrospectively reviewed.
One of 3 treatment arms: transarticular screw fixation alone, dorsal bridge plating alone or a combination of dorsal bridge and transarticular screw fixation.
The primary outcome measures were 1 of 2 midfoot scores-the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score and the Foot Function Index (FFI) Score. Secondary results included postoperative complications.
Quality anatomical reduction is the best predictor of functional outcomes (FFI-P = 0.008, AOFAS-P = 0.02). Functional outcomes with both FFI and AOFAS scores were not significantly associated with any of the fixation groups (FFI-P = 0.495, AOFAS-P = 0.654) on univariate analysis. Injury type by Myerson classification systems or open versus closed status was also not significantly associated with any fixation group. Open exposures were more likely to result in soft-tissue complications, but there was no significant difference in metalware failure or need for removal.
Functional outcomes after Lisfranc fractures are most dependant on the quality of anatomical reduction and not the choice of fixation implant used.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定经关节螺钉、背侧桥接钢板或两者联合使用在Lisfranc损伤后是否能带来最佳功能结果。
病例系列研究。
一级创伤中心。
回顾性分析了5年间接受Lisfranc损伤手术固定的50例患者。
三个治疗组之一：单纯经关节螺钉固定、单纯背侧桥接钢板固定或背侧桥接与经关节螺钉联合固定。
主要观察指标为两个中足评分之一——美国矫形足踝协会（AOFAS）中足评分和足部功能指数（FFI）评分。次要结果包括术后并发症。
解剖复位质量是功能结果的最佳预测指标（FFI - P = 0.008，AOFAS - P = 0.02）。单因素分析显示，FFI和AOFAS评分的功能结果与任何固定组均无显著相关性（FFI - P = 0.495，AOFAS - P = 0.654）。Myerson分类系统的损伤类型或开放性与闭合性状态与任何固定组也无显著相关性。开放性手术更易导致软组织并发症，但在金属植入物失败或取出需求方面无显著差异。
Lisfranc骨折后的功能结果主要取决于解剖复位质量，而非所使用的固定植入物的选择。
治疗性三级证据。有关证据级别的完整描述，请参阅作者指南。
