Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
JBJS Rev. 2023 Apr 4;11(4). doi: e22.00239. eCollection 2023 Apr 1.
»: There is a spectrum of midtarsal injuries, ranging from mild midfoot sprains to complex Lisfranc fracture-dislocations.
»: Use of appropriate imaging can reduce patient morbidity, by reducing the number of missed diagnoses and, conversely, avoiding overtreatment. Weight-bearing radiographs are of great value when investigating the so-called subtle Lisfranc injury.
»: Regardless of the operative strategy, anatomical reduction and stable fixation is a prerequisite for a satisfactory outcome in the management of displaced injuries.
»: Fixation device removal is less frequently reported after primary arthrodesis compared with open reduction and internal fixation based on 6 published meta-analyses. However, the indications for further surgery are often unclear, and the evidence of the included studies is of typically low quality. Further high-quality prospective randomized trials with robust cost-effectiveness analyses are required in this area.
»: We have proposed an investigation and treatment algorithm based on the current literature and clinical experience of our trauma center.
中足损伤谱范围很广，从轻度中足扭伤到复杂的跖跗关节骨折脱位。
使用适当的影像学检查可以减少患者的发病率，减少漏诊的数量，反之，也可以避免过度治疗。当检查所谓的微妙跖跗关节损伤时，负重 X 线片非常有价值。
无论采用何种手术策略，解剖复位和稳定固定都是治疗移位损伤的满意结果的前提。
基于 6 项已发表的荟萃分析，与切开复位内固定相比，初次关节融合术后固定装置取出的报道较少。然而，进一步手术的适应证通常不明确，纳入研究的证据质量通常较低。在这一领域还需要进一步开展高质量的前瞻性随机试验，并进行稳健的成本效益分析。
我们根据当前的文献和我们创伤中心的临床经验提出了一种检查和治疗的算法。
