Department of Trauma & Orthopaedics, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.
Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK.
Bone Joint J. 2024 Dec 1;106-B(12):1431-1442. doi: 10.1302/0301-620X.106B12.BJJ-2024-0581.R1.
Lisfranc injuries were previously described as fracture-dislocations of the tarsometatarsal joints. With advancements in modern imaging, subtle Lisfranc injuries are now more frequently recognized, revealing that their true incidence is much higher than previously thought. Injury patterns can vary widely in severity and anatomy. Early diagnosis and treatment are essential to achieve good outcomes. The original classification systems were anatomy-based, and limited as tools for guiding treatment. The current review, using the best available evidence, instead introduces a stability-based classification system, with weightbearing radiographs and CT serving as key diagnostic tools. Stable injuries generally have good outcomes with nonoperative management, most reliably treated with immobilization and non-weightbearing for six weeks. Displaced or comminuted injuries require surgical intervention, with open reduction and internal fixation (ORIF) being the most common approach, with a consensus towards bridge plating. While ORIF generally achieves satisfactory results, its effectiveness can vary, particularly in high-energy injuries. Primary arthrodesis remains niche for the treatment of acute injuries, but may offer benefits such as lower rates of post-traumatic arthritis and hardware removal. Novel fixation techniques, including suture button fixation, aim to provide flexible stabilization, which theoretically could improve midfoot biomechanics and reduce complications. Early findings suggest promising functional outcomes, but further studies are required to validate this method compared with established techniques. Future research should focus on refining stability-based classification systems, validation of weightbearing CT, improving rehabilitation protocols, and optimizing surgical techniques for various injury patterns to ultimately enhance patient outcomes.
Lisfranc 损伤以前被描述为跗跖关节的骨折脱位。随着现代影像学的进步，现在更频繁地发现细微的 Lisfranc 损伤，揭示其真实发病率远高于先前的认识。损伤模式在严重程度和解剖结构上差异很大。早期诊断和治疗对于获得良好的结果至关重要。最初的分类系统基于解剖结构，作为指导治疗的工具有限。本综述使用最佳现有证据引入了一种基于稳定性的分类系统，负重 X 线和 CT 作为关键诊断工具。稳定的损伤通常采用非手术治疗可获得良好的结果，最可靠的方法是固定和非负重 6 周。移位或粉碎性损伤需要手术干预，切开复位内固定（ORIF）是最常见的方法，桥接钢板固定是共识。虽然 ORIF 通常能取得满意的结果，但效果可能因损伤类型而异，特别是高能损伤。急性损伤的初次关节融合术仍然是一种小众治疗方法，但可能具有降低创伤后关节炎和去除内固定物的发生率等优势。新型固定技术，包括缝线纽扣固定，旨在提供灵活的稳定性，理论上可以改善中足生物力学并减少并发症。早期研究结果表明该方法具有有前景的功能结果，但需要进一步的研究来验证与现有技术相比的这种方法。未来的研究应集中在完善基于稳定性的分类系统、验证负重 CT、改进康复方案以及优化各种损伤模式的手术技术上，最终提高患者的治疗效果。
