Stavrakakis Ioannis, Sperelakis Ioannis, Zampetakis Konstantinos, Tsioupros Alexandros, Kotsis Alkison, Zikopoulos Alexandros, Konstantas Orestis, Mavrogenis Andreas F, Tosounidis Theodoros H
Department of Orthopaedic Surgery, Venizeleio and Pananio General Hospital, Heraklion, Crete, Greece.
Department of Orthopaedic Surgery, Medical School, University of Crete, Heraklion, Crete, Greece.
Eur J Orthop Surg Traumatol. 2025 Jun 23;35(1):271. doi: 10.1007/s00590-025-04387-1.
To investigate the clinical and radiographic outcomes of Lisfranc injuries treated with open reduction and internal fixation.
A retrospective cohort study reporting on the operative management of Lisfranc injuries was conducted across three institutions. Data from adult patients who sustained a tarsometatarsal joint fracture dislocation and were treated with open reduction and internal fixation from 1 January 2020 to 31 December 2023 were collected. The mean AOFAS midfoot score, the incidence of post-traumatic arthritis (PTA) and the complications were reported. The AOFAS score of anatomically reduced TMT joints was compared to the AOFAS score of the non-anatomically reduced TMT joints. The correlation of PTA to the quality of reduction was also evaluated.
Thirty-six (36) consecutive adult patients were retrieved from the digital patient registry. Thirty-two (32) patients completed the six-month follow-up (FU) and were included in the study. The mean AOFAS score of the entire cohort was 89,44 (range 70-100). The anatomically reduced fractures demonstrated a mean AOFAS score of 91,41 (95% CI 88,14-94,68), whereas the mean AOFAS score of the non-anatomically reduced Lisfranc joints was 85,10 (95% CI 77,38-92,82). This difference was statistically significant (p-value: 0,031). Thirteen (13) of 32 patients (40,6%) developed PTA. PTA occurrence was strongly correlated to the quality of reduction (OR: 4,33, 95% CI 1,60-11,69, p-value < 0,001). Four patients developed complex regional pain syndrome (CRPS), and broken implants were identified in four patients. One patient developed metatarsalgia, one deep infection and another one a painless flatfoot. High-energy injuries, PTA and obesity were the most important factors negatively affecting the outcome.
A better outcome and a lower risk of PTA were correlated with anatomically reduced Lisfranc fracture dislocations. The most commonly documented complications were PTA, implant breakage and CRPS.
探讨切开复位内固定治疗Lisfranc损伤的临床及影像学结果。
在三家机构开展一项关于Lisfranc损伤手术治疗的回顾性队列研究。收集2020年1月1日至2023年12月31日期间因跗跖关节骨折脱位接受切开复位内固定治疗的成年患者的数据。报告平均美国足踝外科协会（AOFAS）中足评分、创伤后关节炎（PTA）的发生率及并发症情况。比较解剖复位的跗跖关节的AOFAS评分与非解剖复位的跗跖关节的AOFAS评分。还评估了PTA与复位质量的相关性。
从数字患者登记系统中检索出36例连续的成年患者。32例患者完成了6个月的随访（FU）并纳入研究。整个队列的平均AOFAS评分为89.44（范围70 - 100）。解剖复位的骨折平均AOFAS评分为91.41（95%可信区间88.14 - 94.68），而非解剖复位的Lisfranc关节平均AOFAS评分为85.10（95%可信区间77.38 - 92.82）。这种差异具有统计学意义（p值：0.031）。32例患者中有13例（40.6%）发生了PTA。PTA的发生与复位质量密切相关（比值比：4.33，95%可信区间1.60 - 11.69，p值<0.001）。4例患者发生了复杂性区域疼痛综合征（CRPS），4例患者发现植入物断裂。1例患者出现跖痛症，1例发生深部感染，另1例出现无痛性扁平足。高能损伤、PTA和肥胖是对结果产生负面影响的最重要因素。
解剖复位的Lisfranc骨折脱位与更好的结果及更低的PTA风险相关。最常见的并发症为PTA、植入物断裂和CRPS。
