Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea.
Int Orthop. 2024 Nov;48(11):2911-2921. doi: 10.1007/s00264-024-06320-3. Epub 2024 Sep 19.
This study aimed to evaluate and compare the clinico-radiographic outcomes between two techniques for acute Lisfranc fracture-dislocation with a large, displaced second metatarsal base plantar fracture: isolated Lisfranc screw fixation versus Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base.
We retrospectively compared the clinico-radiographic outcome between patients who underwent isolated Lisfranc screw fixation (Group 1, 26 patients) and those who underwent Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base (Group 2, 23 patients). The main outcome measurements were the postoperative distance between the medial cuneiform and second metatarsal base on standing anteroposterior foot radiographs, known as the C1-M2 distance. Residual diastasis was defined as C1-M2 distance ≥ 2 mm on the affected side compared with that on the contralateral side. We also assessed the Foot and Ankle Ability Measure (FAAM)-activities of daily living (ADL) and sports subscale scores at three, six and ≥ 18 months postoperatively.
At the final follow-up, the mean C1-M2 distance on the affected side compared with that on the contralateral side was significantly greater in Group 1 than in Group 2 (3.9 versus 0.7 mm, P = 0.027). Furthermore, Group 1 showed a higher incidence of residual diastases at the final follow-up (69.2%) than the Group 2 (13.0%, P < 0.001). The FAAM-ADL scores at the final follow-up did not differ significantly between the groups (P = 0.518), but the FAAM Sports score was significantly higher in Group 2 than in Group 1 (P = 0.001).
The postoperative C1-M2 distance was better maintained with Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base than with isolated Lisfranc screw fixation. We recommend that surgeons exercise caution when dealing with a second metatarsal plantar fracture and consider performing secure fixation using the dorsoplantar miniscrew technique for improved clinical outcomes.
本研究旨在评估和比较两种治疗急性跖骨基底较大、移位的第二跖骨底骨折的 Lisfranc 骨折脱位的临床-影像学结果：单纯 Lisfranc 螺钉固定与 Lisfranc 关节固定联合第二跖骨基底背侧-足底微型螺钉固定。
我们回顾性比较了接受单纯 Lisfranc 螺钉固定（第 1 组，26 例）和 Lisfranc 关节固定联合第二跖骨基底背侧-足底微型螺钉固定（第 2 组，23 例）的患者的临床-影像学结果。主要观察指标为站立前后位足部 X 线片上内侧楔骨和第二跖骨基底之间的术后距离，称为 C1-M2 距离。残留间隙定义为患侧 C1-M2 距离较对侧≥2mm。我们还评估了术后 3、6 和≥18 个月的足踝能力测量（FAAM）-日常生活活动（ADL）和运动亚量表评分。
在最终随访时，第 1 组患侧 C1-M2 距离与对侧比较显著大于第 2 组（3.9 毫米比 0.7 毫米，P=0.027）。此外，第 1 组在最终随访时残留间隙的发生率明显高于第 2 组（69.2%比 13.0%，P<0.001）。最终随访时两组的 FAAM-ADL 评分无显著差异（P=0.518），但第 2 组的 FAAM 运动评分明显高于第 1 组（P=0.001）。
与单纯 Lisfranc 螺钉固定相比，Lisfranc 关节固定联合第二跖骨基底背侧-足底微型螺钉固定能更好地维持术后 C1-M2 距离。我们建议外科医生在处理第二跖骨跖骨骨折时要谨慎，并考虑使用背侧-足底微型螺钉技术进行牢固固定，以获得更好的临床效果。
