Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH; and.
Department of Orthopaedic Surgery, University of Colorado, Denver, CO.
J Orthop Trauma. 2024 May 1;38(5):e169-e174. doi: 10.1097/BOT.0000000000002780.
To evaluate patients with tarsometatarsal fractures and dislocations and describe complications and secondary operations.
Retrospective cohort study.
Level 1 trauma center.
Consecutive adults treated acutely for Lisfranc injuries with reduction and fixation using standard techniques of rigid medial fixation and flexible lateral fixation.
Complications include infections, wound healing problems, nonunion, malunion, and posttraumatic arthrosis (PTA), and secondary unplanned procedures after a minimum of 2-year radiographic follow-up.
Mean age of the included 118 patients was 40 years (range, 18-73 years) and 96 (74%) were male. Comorbidities included obesity (n = 32; 40%), diabetes mellitus (n = 12; 9%), and tobacco use (n = 67; 52%). Thirty (23%) were open injuries, and concomitant forefoot injuries were present in 47% and hindfoot injuries in 12%. Unplanned secondary procedures, including implant removals, were performed on 39 patients (33%), most often for removal of painful implants (26%) or infectious debridement (9%). Sixty-seven complications occurred, with PTA most frequent (37%). Deep infections occurred in 8%. On multivariate analysis, open injury ( P = 0.028, CI = 1.22-30.63, OR = 6.12) and concomitant forefoot injury ( P = 0.03, CI = 1.12-9.76, OR = 3.31) were independent risk factors for complication.
Open Lisfranc injuries were associated with complications, with deep infections occurring in 9%. Secondary procedures were most often performed for pain relief; the most common late complication was PTA, warranting counseling of patients about potential long-term sequelae of injury.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估跗跖关节骨折脱位患者的情况，描述并发症和二次手术。
回顾性队列研究。
1 级创伤中心。
连续接受采用刚性内侧固定和柔性外侧固定的标准技术复位和固定治疗的急性 Lisfranc 损伤的成人患者。
并发症包括感染、伤口愈合问题、骨不连、畸形愈合和创伤后关节炎（PTA），以及在至少 2 年放射随访后计划外的二次手术。
纳入的 118 例患者的平均年龄为 40 岁（范围，18-73 岁），96 例（74%）为男性。合并症包括肥胖（n = 32；40%）、糖尿病（n = 12；9%）和吸烟（n = 67；52%）。30 例（23%）为开放性损伤，47%合并前足损伤，12%合并后足损伤。包括植入物去除在内的 39 例（33%）计划外二次手术，主要原因是去除疼痛植入物（26%）或感染清创（9%）。共发生 67 例并发症，最常见的是 PTA（37%）。深部感染发生率为 8%。多变量分析显示，开放性损伤（P = 0.028，CI = 1.22-30.63，OR = 6.12）和前足合并损伤（P = 0.03，CI = 1.12-9.76，OR = 3.31）是并发症的独立危险因素。
开放性 Lisfranc 损伤与并发症相关，深部感染发生率为 9%。二次手术主要是为了缓解疼痛；最常见的晚期并发症是 PTA，需要对患者进行潜在长期损伤后果的咨询。
预后 III 级。请参阅作者说明，以获得完整的证据水平描述。
