School of Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
Foot Ankle Int. 2022 Oct;43(10):1308-1316. doi: 10.1177/10711007221112090. Epub 2022 Jul 28.
Lisfranc injuries are among the most debilitating injuries to the foot. Characterization of first tarsometatarsal (TMT) joint involvement in Lisfranc injuries is limited. Multiple studies have indicated that this joint is damaged in a variety of Lisfranc injury patterns, but there is sparse information regarding how often and in what form.
A retrospective review was performed of operative Lisfranc fractures from 2010 to 2020 with patients identified by codes. Hardcastle and Myerson Lisfranc injury classifications and computed tomography and radiograph characterizations of the first TMT joint were evaluated by 3 foot and ankle fellowship-trained orthopaedic surgeons. Radiographic characteristics were collected. Light's kappa coefficient evaluated interrater reliability for injury classification. Injury mechanism and Lisfranc classification effects on the first TMT joint were further assessed using inferential statistics.
Of 71 patients with a Lisfranc injury of which 37 (52%) were high energy, 61 (86%) showed radiographic evidence of first TMT joint injury. A fragment was present in the TMT articular surface in 33 (47%) with median size = 8.7 mm and medial capsular avulsion in n = 25 (35%). Forty-eight patients (68%) had medial/lateral TMT joint incongruence ≥2 mm (median overhang = 4 mm), 21 (30%) had dorsal/plantar incongruence (median overhang = 6 mm). Angulation of TMT articular surfaces ≥5 degrees on the transverse/anteroposterior plane occurred in n = 32 (45%) and in n = 12 (17%) on the sagittal/lateral plane, which significantly differed between classifications ( = .020).
The overwhelming majority of Lisfranc midfoot injuries seen at our tertiary referral center had imaging evidence of damage to the first TMT joint (86%), and the incidence may be higher. The most common patterns of first TMT joint involvement we found were joint incongruity, articular surface fractures, angulation of the articular surfaces, and medial capsular ligament avulsion fractures. A better understanding of injuries to the first TMT joint can help orthopaedic surgeons with diagnosis.
跖跗关节损伤是足部最具致残性的损伤之一。跖跗关节在 Lisfranc 损伤中的受累特征描述有限。多项研究表明，该关节在多种 Lisfranc 损伤模式中均受到损伤，但关于其受累的频率和形式的信息却很少。
对 2010 年至 2020 年期间通过 代码识别的手术治疗的 Lisfranc 骨折进行回顾性研究。3 位足踝 fellowship培训的骨科医生评估了 Hardcastle 和 Myerson 的 Lisfranc 损伤分类以及第一跖楔关节的计算机断层扫描和 X 线特征。收集 X 线特征。采用 Light 的 Kappa 系数评估损伤分类的组内一致性。使用推断统计学进一步评估损伤机制和 Lisfranc 分类对第一跖楔关节的影响。
在 71 例 Lisfranc 损伤患者中，37 例（52%）为高能量损伤，61 例（86%）X 线显示第一跖楔关节损伤证据。33 例（47%）的跖楔关节关节面存在骨折碎片，中位数大小为 8.7mm，25 例（35%）存在内侧关节囊撕脱。48 例（68%）患者的跖楔关节内侧/外侧关节不重合≥2mm（中位数重叠 4mm），21 例（30%）存在背侧/跖侧关节不重合（中位数重叠 6mm）。32 例（45%）在横/前后位平面上的跖楔关节面成角≥5 度，12 例（17%）在矢状/侧位平面上成角≥5 度，两种分类之间差异显著（ =.020）。
在我们的三级转诊中心，绝大多数所见的 Lisfranc 中足损伤均有第一跖楔关节损伤的影像学证据（86%），且发生率可能更高。我们发现的第一跖楔关节受累最常见的模式是关节不重合、关节面骨折、关节面成角和内侧关节囊韧带撕脱骨折。更好地了解第一跖楔关节的损伤有助于骨科医生进行诊断。
