Casciato Dominick J, Chandra Amar, Nguyen Kevin, Starcher Nathaniel, Thompson John, Mendicino Robert W, Taylor Benjamin C
Resident Physician, OhioHealth Grant Medical Center, Columbus, OH.
Resident Physician, OhioHealth Grant Medical Center, Columbus, OH.
J Foot Ankle Surg. 2023 Jan-Feb;62(1):173-177. doi: 10.1053/j.jfas.2022.06.008. Epub 2022 Jun 28.
Lisfranc injuries present a challenge due to their ubiquity though frequent missed diagnoses. A paucity of data exists associating the contribution of bone density to injury type. This investigation compares the regional bone density between Lisfranc injury types using computed-tomography (CT)-derived Hounsfield units. A retrospective chart review identified patients with gross ligamentous and avulsion-type Lisfranc injuries determined by CT examination of the second metatarsal base and medial cuneiform. Regional bone density was assessed by averaging the Hounsfield units of the first metatarsal base, navicular, cuboid, calcaneus, and talus between 2 reviewers. Density was compared between injury type, isolated concomitant forefoot, and mid/hindfoot fractures. One hundred thirty-four patients were separated into avulsion (n = 85) and ligamentous (n = 49) groups. No statistically significant difference in patient body mass index, age, smoking status, or Quenu and Kuss injury pattern was observed between groups. The regional bone density of the cuboid (p = .03) and talus (p = .04) was greater in the ligamentous group. Lower extremity concomitant mid/hindfoot fracture patients exhibited greater regional bone density in the ligamentous group in all assessed bones (p ≤ .04) except the calcaneus. Ligamentous injuries of the Lisfranc complex are associated with increased regional bone density among patients sustaining concomitant mid/hindfoot fractures. This study expands the utility of regional bone density analysis in foot and ankle trauma.
由于利斯弗朗损伤普遍存在且经常漏诊，因此其治疗颇具挑战性。目前关于骨密度对损伤类型影响的数据较少。本研究使用计算机断层扫描（CT）得出的亨氏单位，比较了不同类型利斯弗朗损伤的局部骨密度。一项回顾性图表审查确定了通过第二跖骨基底和内侧楔骨的CT检查确诊为严重韧带损伤和撕脱型利斯弗朗损伤的患者。由两名评估人员对第一跖骨基底、舟骨、骰骨、跟骨和距骨的亨氏单位进行平均，以评估局部骨密度。比较了损伤类型、孤立性合并前足损伤以及中/后足骨折之间的骨密度。134名患者被分为撕脱组（n = 85）和韧带组（n = 49）。两组患者在体重指数、年龄、吸烟状况或凯努和库斯损伤模式方面均未观察到统计学上的显著差异。韧带组的骰骨（p = 0.03）和距骨（p = 0.04）局部骨密度更高。在所有评估的骨骼中，除跟骨外，伴有中/后足骨折的下肢患者在韧带组中的局部骨密度更高（p≤0.04）。利斯弗朗复合体的韧带损伤与伴有中/后足骨折患者的局部骨密度增加有关。本研究扩展了局部骨密度分析在足踝创伤中的应用。
