Sroka Oliver, Campbell Megan, Thorne Tyler, Haller Justin, Rothberg David, Higgins Thomas, Marchand Lucas
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
J Orthop Trauma. 2025 Feb 1;39(2):90-95. doi: 10.1097/BOT.0000000000002927.
The purpose of this study was to investigate whether hardware removal (HWR) after Lisfranc open reduction and internal fixation (ORIF) resulted in significant impact through PROMIS physical function (PF) and pain intensity (PI) scores.
Retrospective cohort.
Level-1 trauma center.
Adult patients with isolated Lisfranc injuries who were treated through ORIF between 2002 and 2023 who had PROMIS PF and PI scores through 6 months follow-up were included. Patients were excluded if they received index treatment other than ORIF or underwent secondary surgical intervention before HWR. A subanalysis was performed at 1-year follow-up.
Primary outcomes were PROMIS PF and PI scores. The Wilcoxon signed-rank test compared differences between PROMIS scores within the HWR group. The Wilcoxon ranked-sum test compared differences between HWR versus no HWR. Distributive MCID was calculated using the 0.5 SD method.
There were 482 patients (489 feet) identified with isolated Lisfranc injuries. Seventy-seven feet underwent ORIF followed by HWR. Thirty feet underwent ORIF without HWR. The average age of the no HWR group was 45.8 (18.0-81.3) years versus the HWR group that was 38.7 (18.3-74.1) years ( P = 0.053). Nineteen (63.3%) were women in the no HWR group compared with 33 (42.9%) in the HWR group ( P = 0.084). HWR occurred an average of 4.43 months after ORIF. Patients who underwent HWR had a statistically significant increase in average PF scores (39.7-45.9, P < 0.001) at their standard 6 weeks (1.5 months) postoperative visit. HWR patients had a nonsignificant decrease in average PI scores (56.5-53.9, P = 0.24). Compared with those with retained hardware, the HWR group demonstrated a statistically significant net improvement in PF and PI scores from surgery, with an average improvement of 5.6 and 1.7, respectively ( P = 0.002, 0.008).
Patients experienced significant improvement in PROMIS PF scores for Lisfranc ORIF at 6 weeks after HWR. Compared with patients with retained hardware, they also experienced significant improvement in PROMIS PF and PI scores.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
本研究旨在调查Lisfranc切开复位内固定术（ORIF）后取出内固定装置（HWR）是否会通过患者报告结果测量信息系统（PROMIS）的身体功能（PF）和疼痛强度（PI）评分产生显著影响。
回顾性队列研究。
一级创伤中心。
纳入2002年至2023年间接受ORIF治疗的孤立性Lisfranc损伤成年患者，这些患者在6个月随访期内有PROMIS PF和PI评分。如果患者接受了ORIF以外的首次治疗或在HWR之前接受了二次手术干预，则将其排除。在1年随访时进行亚分析。
主要结果是PROMIS PF和PI评分。Wilcoxon符号秩检验比较了HWR组内PROMIS评分之间的差异。Wilcoxon秩和检验比较了HWR组与未进行HWR组之间的差异。使用0.5标准差方法计算分布性最小临床重要差异（MCID）。
共识别出482例（489足）孤立性Lisfranc损伤患者。7只足接受了ORIF并随后取出内固定装置。30只足接受了ORIF但未取出内固定装置。未取出内固定装置组的平均年龄为45.8（18.0 - 81.3）岁，而取出内固定装置组为38.7（18.3 - 74.1）岁（P = 0.053）。未取出内固定装置组中19例（63.3%）为女性，而取出内固定装置组中为33例（42.9%）（P = 0.084）。HWR平均在ORIF后4.43个月进行。接受HWR的患者在术后标准6周（1.5个月）随访时平均PF评分有统计学显著提高（从39.7提高到45.9，P < 0.001）。HWR患者的平均PI评分有非显著下降（从56.5降至53.9，P = 0.24）。与保留内固定装置的患者相比，HWR组在PF和PI评分方面从手术时有统计学显著的净改善，平均改善分别为5.6和1.7（P = 0.002，0.008）。
患者在HWR后6周时，Lisfranc ORIF的PROMIS PF评分有显著改善。与保留内固定装置的患者相比，他们在PROMIS PF和PI评分方面也有显著改善。
治疗性三级。有关证据水平的完整描述，请参阅作者指南。
