Department of Orthopaedics, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Foot Ankle Int. 2023 Oct;44(10):960-967. doi: 10.1177/10711007231181121. Epub 2023 Jun 21.
Midfoot fractures and dislocations are infrequent and functional outcomes following Lisfranc injuries have not been well described. The purpose of this project was to explore functional outcomes following operative treatment of high-energy Lisfranc injury.
A retrospective cohort of 46 adults with tarsometatarsal fractures and dislocations treated at a single Level 1 trauma center were reviewed. Demographic, medical, social, and injury features of these patients and their injuries were recorded. Foot Function Index (FFI) and Short Musculoskeletal Function Assessment (SMFA) surveys were collected after mean 8.7 years' follow-up. Multiple linear regression was performed to identify independent predictors of outcome.
Forty-six patients with mean age 39.7 years completed functional outcome surveys. Mean SMFA scores were 29.3 (dysfunction) and 32.6 (bothersome). Mean FFI scores were 43.1 (pain), 43.0 (disability), and 21.7 (activity), with a mean total score of 35.9. FFI pain scores were worse than published values for fractures of the plafond (33, = .04), distal tibia (33, = .04), and talus (25.3, = .001). Lisfranc injury patients reported worse disability (43.0 vs 29, = .008) and total FFI scores (35.9 vs 26, = .02) compared with distal tibia fractures. Tobacco smoking was an independent predictor of worse FFI ( < .05) and SMFA emotion and bothersome scores ( < .04). Chronic renal disease was a predictor of worse FFI disability ( = .04) and SMFA subcategory scores ( < .04). Male sex was associated with better scores in all SMFA categories ( < .04). Age, obesity, or open injury did not affect functional outcomes.
Patients reported worse pain by FFI after Lisfranc injury compared to other injuries about the foot and ankle. Tobacco smoking, female sex, and preexisting chronic renal disease are predictive of worse functional outcome scores, warranting further study in a larger sample, as well as counseling of long-term consequences of this injury.
Level IV, retrospective, prognostic.
中足骨折和脱位并不常见，Lisfranc 损伤后的功能结果也没有得到很好的描述。本项目的目的是探讨高能量 Lisfranc 损伤手术治疗后的功能结果。
对在一家一级创伤中心接受治疗的 46 例成人跗跖骨骨折和脱位患者进行回顾性队列研究。记录这些患者及其损伤的人口统计学、医疗、社会和损伤特征。在平均 8.7 年的随访后收集足部功能指数（FFI）和短肌肉骨骼功能评估（SMFA）调查。进行多元线性回归以确定结局的独立预测因素。
46 例平均年龄为 39.7 岁的患者完成了功能结局调查。SMFA 评分的平均值为 29.3（功能障碍）和 32.6（困扰）。FFI 评分的平均值为 43.1（疼痛）、43.0（残疾）和 21.7（活动），总分为 35.9。FFI 疼痛评分差于公布的足底（33， = .04）、胫骨远端（33， = .04）和距骨（25.3， = .001）骨折的评分。Lisfranc 损伤患者报告的残疾（43.0 比 29， = .008）和总 FFI 评分（35.9 比 26， = .02）比胫骨远端骨折患者差。吸烟是 FFI（ < .05）和 SMFA 情绪和困扰评分（ < .04）更差的独立预测因素。慢性肾病是 FFI 残疾（ = .04）和 SMFA 亚类评分（ < .04）更差的预测因素。男性在所有 SMFA 类别中的评分都更好（ < .04）。年龄、肥胖或开放性损伤并不影响功能结局。
与足踝部其他损伤相比，Lisfranc 损伤患者报告的 FFI 疼痛更严重。吸烟、女性和慢性肾脏疾病是功能结局评分更差的预测因素，需要在更大的样本中进一步研究，并对该损伤的长期后果进行咨询。
IV 级，回顾性，预后。
