Meng-Qiang Fan1, Xu-Song Li2, Xian-Jun Jiang3, Jian-Jian Shen4, Pei-Jian Tong5, Jie-Feng Huang6. 1. Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang, China; The First Clinical College, Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang, China. Electronic address: 741216599@qq.com. 2. Department of Orthopaedics & Traumatology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan 528401, Guangdong, China. Electronic address: lxszhongshan@163.com. 3. Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang, China; The First Clinical College, Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang, China. Electronic address: 772121361@qq.com. 4. Department of Orthopaedics, Affiliated Cixi Hospital of Wenzhou Medical University, Cixi 315300, Zhejiang, China. Electronic address: cryorthopaedic@163.com. 5. Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang, China; The First Clinical College, Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang, China. Electronic address: tpj637963@163.com. 6. Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang, China; The First Clinical College, Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang, China. Electronic address: 40983285@qq.com.
Abstract
BACKGROUND: This study assessed the surgical outcomes of Lisfranc injuries accompanied by multiple metatarsal fractures. Metatarsal fractures here refers to metatarsal head, neck, and shaft (including shaft fractures accompanied by fractures of the base) fractures, as well as mixed (i.e., segmental fracture) fractures, as seen on imaging studies. METHODS: Between 2002 and 2015, one hundred and seventy-six patients were followed-up for a mean of 92 months, including eight patients who underwent secondary arthrodesis due to severe arthritis after ORIF. All the patients underwent surgical fusion (primary partial arthrodesis, PPA; n = 78) or non-fusion (percutaneous or open reduction and internal fixation, ORIF; n = 98) procedures and the outcomes were evaluated by clinical examinations, radiography, visual analogue scale (VAS) pain score, the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, the Foot and Ankle Outcome Score (FAOS), and the Short Form (SF)-36 physical and SF-36 mental questionnaires. The parameters between the fusion and non-fusion groups were analyzed by repeated-measures ANOVA. Statistically significant differences between the two groups were then further analyzed using a two-independent-samples t-test. RESULTS: Anatomical reduction was achieved in 161 patients. At the last follow-up, the mean AOFAS score was 74.67 (range: 39-91) in the non-fusion group and 82.79 (range: 67-97) in the fusion group (P = 0.003). The PPA and ORIF groups differed significantly with respect to the VAS pain score (1.93 vs. 1.21), the SF-36 physical (75.87 vs. 80.90) and mental (75.76 vs. 81.33) components, and the FAOS pain (72.74 vs. 84.06), symptoms (71.87 vs. 82.49), activities of daily life (ADLs: 73.12 vs. 81.54), sport/recreation (sport/rec: 57.99 vs. 73.23), and quality of life (QoL: 79.95 vs. 86.67) components. In the ORIF group, 23 patients had mild/moderate post-traumatic osteoarthritis. CONCLUSIONS: With longer and more conservative postoperative management, fusion results in a better outcome than non-fusion in the treatment of Lisfranc injuries accompanied by multiple metatarsal fractures.
BACKGROUND: This study assessed the surgical outcomes of Lisfranc injuries accompanied by multiple metatarsal fractures. Metatarsal fractures here refers to metatarsal head, neck, and shaft (including shaft fractures accompanied by fractures of the base) fractures, as well as mixed (i.e., segmental fracture) fractures, as seen on imaging studies. METHODS: Between 2002 and 2015, one hundred and seventy-six patients were followed-up for a mean of 92 months, including eight patients who underwent secondary arthrodesis due to severe arthritis after ORIF. All the patients underwent surgical fusion (primary partial arthrodesis, PPA; n = 78) or non-fusion (percutaneous or open reduction and internal fixation, ORIF; n = 98) procedures and the outcomes were evaluated by clinical examinations, radiography, visual analogue scale (VAS) pain score, the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, the Foot and Ankle Outcome Score (FAOS), and the Short Form (SF)-36 physical and SF-36 mental questionnaires. The parameters between the fusion and non-fusion groups were analyzed by repeated-measures ANOVA. Statistically significant differences between the two groups were then further analyzed using a two-independent-samples t-test. RESULTS: Anatomical reduction was achieved in 161 patients. At the last follow-up, the mean AOFAS score was 74.67 (range: 39-91) in the non-fusion group and 82.79 (range: 67-97) in the fusion group (P = 0.003). The PPA and ORIF groups differed significantly with respect to the VAS pain score (1.93 vs. 1.21), the SF-36 physical (75.87 vs. 80.90) and mental (75.76 vs. 81.33) components, and the FAOS pain (72.74 vs. 84.06), symptoms (71.87 vs. 82.49), activities of daily life (ADLs: 73.12 vs. 81.54), sport/recreation (sport/rec: 57.99 vs. 73.23), and quality of life (QoL: 79.95 vs. 86.67) components. In the ORIF group, 23 patients had mild/moderate post-traumatic osteoarthritis. CONCLUSIONS: With longer and more conservative postoperative management, fusion results in a better outcome than non-fusion in the treatment of Lisfranc injuries accompanied by multiple metatarsal fractures.
Authors: Patrick Pflüger; Michael Zyskowski; Christopher Völk; Chlodwig Kirchhoff; Peter Biberthaler; Moritz Crönlein Journal: Unfallchirurg Date: 2021-05-22 Impact factor: 1.000