一期切开复位内固定治疗Lisfranc关节损伤疗效分析

目的探讨一期切开复位内固定治疗Lisfranc关节损伤的临床疗效。方法对30例Lisfranc关节损伤一期行切开复位内固定手术,根据AOFAS功能评分评价术后功能恢复情况。结果30例均获随访6～12个月,平均10．5个月。切口均一期愈合,未发生感染。所有患者足弓形态基本恢复正常,步态基本正常。AOFAS评分：优23例,良3例,可4例,优良率86．7％。结论一期切开复位内固定是治疗Lisfranc关节损伤的有效方法。     

切开复位内固定治疗Lisfranc关节损伤临床疗效观察

目的探讨切开复位内固定治疗Lisfranc关节损伤的临床疗效。方法采用切开复位空心钉内固定治疗Lisfranc关节损伤16例(19足),末次随访时采用AOFAS评分评估术后疗效。结果 16例均获随访3~20个月,平均13个月。末次随访时采用AOFAS评分评估疗效:优9足,良5足,可3足,差2足,优良率73.7%。结论切开复位空心钉内固定治疗Lisfranc关节损伤疗效显著,能够重建跖跗关节复合体的稳定性;损伤程度、术中复位质量与疗效密切相关。     

切开复位内固定治疗Lisfranc损伤疗效观察

目的探讨采用切开复位内固定术治疗Lisfranc损伤的可行性和疗效。方法自2012-01—2013-09采用切开复位内固定术治疗15例Lisfranc损伤,Lisfranc关节内侧柱和中间柱用空心钉刚性固定,外侧柱行克氏针弹性固定。术后采用AOFAS评分标准进行足踝功能评估。结果本组术后X线片显示14例获得解剖复位。术后所有患者获得随访2~19个月,平均11个月。末次随访时AOFAS足踝评分:优9例,良4例,可2例。6例在随访过程中发现Lisfranc关节骨性关节炎,其中1例久行后出现跖跗关节处疼痛。结论切开复位内固定治疗Lisfranc损伤疗效满意,术中解剖复位、稳定固定,以及确保后期复位不丢失是获得满意疗效的关键。     

一期有限植骨融合术治疗Lisfranc损伤

目的探讨一期植骨融合术治疗Chiodo三柱损伤分类中合并中间柱第2和（或）第3跖跗关节Lisfranc损伤的临床疗效。方法合并中间柱第2和（或）第3跖跗关节面损伤的Lisfranc损伤9例,中间柱第2和（或）第3跖跗关节采用切开复位植骨融合微型钢板内固定,内侧柱采用切开复位空心钉内固定,外侧柱采用闭合复位克氏针内固定。结果 9例均获随访10-36（22.5±2.5）个月,骨折愈合时间10-18（14.0±4.0）周。术后疗效按AOFAS评分标准评定：优5例,良3例,可1例。结论一期有限植骨融合中间柱治疗Lisfranc损伤具有融合关节少、损伤小、疗效可靠等优点。     

切开复位跨关节钢板内固定治疗Lisfranc损伤

目的探讨切开复位跨关节钢板内固定治疗Lisfranc损伤的疗效。方法对47例Lisfranc损伤患者采用切开复位跨关节钢板内固定治疗,根据AOFAS中足评分评价疗效。结果 47例均获得随访,时间12~40个月。末次随记时根据AOFAS中足评分对患者术后足功能进行评定:好26例,较好20例,差1例。随访中发生螺钉断裂1例,克氏针滑脱2例,创伤性关节炎1例。结论解剖复位、稳定固定是Lisfranc损伤获得良好预后的关键。     

闭合复位结合切开复位内固定治疗Lisfranc关节损伤的疗效分析

目的评价采用闭合复位结合切开复位内固定治疗Lisfranc关节损伤的效果。方法应用闭合复位结合切开复位方法,选用空心钉、克氏针为内固定材料,对52例58侧Lisfranc关节损伤患者进行治疗。结果术后随访6～32个月,平均19个月。采用美国足踝外科协会(AOFAS)中足评分标准评定功能:优15侧,良28侧,可10侧,劣5侧。结论采用闭合复位结合切开复位内固定治疗Lisfranc关节损伤可取得良好效果。     

切开复位内固定治疗Lisfranc关节损伤

[目的]总结切开复位内固定治疗Lisfranc关节损伤的临床经验,提高治疗Lisfranc关节损伤的水平.[方法]自2003年7月-2007年10月间,本院共收治30例33侧Lisfranc关节损伤的病人,采用切开复位内固定术.损伤按Quenu-kuss分型,A型5例,B型25例,C型3例.手术采用1～2个足背侧纵行切口,复位后用空心螺钉或克氏针固定.[结果]术后平均随访36个月(6～45个月),根据Maryland足部功能平分(MFS)评估疗效,优良率为76.2%.[结论]切开复位内固定治疗Lisfranc关节损伤,可以取得良好的效果.     

切开复位内固定治疗Lisfranc关节损伤的体会

目的探讨切开复位内固定治疗Lisfranc关节损伤的中短期疗效。方法回顾性分析自2010-01—2013-12诊治的15例Lisfranc关节损伤,分别采用切开复位克氏针、空心钉及背侧钢板内固定,根据美国足踝骨科协会(AOFAS)评分标准对患足术后功能进行评价。结果所有患者均获得随访12~24个月,平均18个月。骨折均达到一期愈合,无皮肤坏死、伤口感染、内固定物断裂、复位丢失等并发症。所有患者均达到解剖复位,根据AOFAS评分标准,平均得分85分,优5例,良9例,可1例。结论切开复位内固定治疗Lisfranc关节损伤可获得良好的中短期疗效满意,能有效恢复患足功能,减少致残率。     

切开复位钢板联合克氏针内固定治疗Lisfranc损伤

目的 探讨Lisfranc损伤应用切开复位钢板联合克氏针内固定方法治疗的临床效果。方法 2015年12月-2021年3月共收治Lisfranc损伤患者11例,应用切开复位钢板联合克氏针内固定方法治疗。所有患者均消肿后择期手术,术后行AOFAS评分评定疗效。结果 术后患者均获随访,随访时间4个月~5年,平均1.5年,AOFAS评分61~97分,平均83.5分,优良率为82.3%。术后1例切口边缘皮肤坏死,换药后愈合;1例发生创伤性关节炎。切口无感染,均一期愈合;脱位完全复位,3~4个月后复查骨折愈合良好。结论 切开解剖复位,钢板联合克氏针固定相对稳定,符合Lisfranc力学原理,该手术方法治疗Lisfranc损伤临床效果满意。     

Lisfranc关节损伤手术治疗的疗效评估

目的：探讨手术治疗Lisfranc关节损伤的临床疗效。方法：自2003年1月至2009年9月,手术治疗Lis-franc关节损伤57例,男41例,女16例;年龄20～64岁,平均33.8岁。按照Myerson分类：中柱损伤31例,中柱合并内侧柱损伤15例,三柱损伤11例。受伤当日手术25例,受伤后3～11d（平均7d）手术32例。结果：切口均一期愈合,平均手术时间50min;所有患者获随访,时间4～70个月,平均35个月。患者平均AOFAS评分为（84.73±14.26）分,患者术后5.1个月（3～12个月）恢复正常生活。52例解剖复位患者平均AOFAS评分（87.63±13.71）,5例未解剖复位者平均AOFAS评分（74.31±21.96）。多柱损伤患者26例平均AOFAS评分（76.58±11.51）。有8例患者并发创伤性骨关节炎,是患者中最主要的并发症。结论：手术治疗Lisfranc关节损伤能够重建跖跗关节复合体的稳定性,可取得满意的复位和临床疗效。术中复位质量与治疗结果密切相关。     

Severe Lisfrancs injuries: primary arthrodesis or ORIF?

Twenty-eight patients, with severe, acute Lisfranc dislocations, requiring operative intervention, were treated between 1989 and 1992 in a level one Trauma Center. Different treatment protocols were used by the two senior staff surgeons. This allowed ORIF to be compared to complete arthrodesis and partial arthrodesis. Twelve patients were treated with primary arthrodesis after open reduction of the dislocation. Partial (5) or complete arthrodesis (6) (depending on the type of fracture) was performed in these 12 patients. Sixteen patients were treated with open reduction and temporary fixation with stabilization and compression screw fixation (ORIF group). The subgroups were identical in age (mean 30.5 years), follow-up (30.1 months), type of fracture, type of injury and time to intervention. Anatomical reduction was achieved in eight of the 12 patients in the arthrodesis groups and in 12 of the 16 patients in the ORIF group. The Baltimore Painful foot Score (PFS) was higher in the ORIF group then in the complete arthrodesis group meaning the ORIF group had less pain. No difference in the PFS was found between the ORIF group and the partial arthrodesis group. Subsequent revision surgery was necessary in two cases in the arthrodesis groups and two cases in the ORIF group. Stiffness of the forefoot, loss of metatarsal arch, and sympathetic dystrophy occurred more frequently in the complete arthrodesis group. Open reduction and internal fixation with screws or partial arthrodesis is the treatment of choice in severe tarsometatarsal fracture dislocations. Primary complete arthrodesis should be reserved as a salvage procedure.     

Cost comparison and complication rate of Lisfranc injuries treated with open reduction internal fixation versus primary arthrodesis

BackgroundControversy exists regarding optimal primary management of Lisfranc injuries. Whether open reduction internal fixation (ORIF) or primary arthrodesis is superior remains unknown.MethodsA national insurance database of approximately 23.5 million orthopedic patients was retrospectively queried for subjects who were diagnosed with a Lisfranc injury from 2007 to 2016 based on international classification of diseases (ICD) codes (PearlDiver, Colorado Springs, CO). Patients with lisfranc injuries then progressed to either nonoperative treatment, ORIF, or primary arthrodesis. Associated treatment costs were determined along with complication rate and hardware removal rate.Results2205 subjects with a diagnosis of Lisfranc injury were identified in the database. 1248 patients underwent nonoperative management, 670 underwent ORIF, and 212 underwent primary arthrodesis. The average cost of care associated with primary arthrodesis was greater ($5005.82) than for ORIF ($3961.97,P = 0.045). The overall complication rate was 23.1% (155/670) for ORIF and 30.2% (64/212) for primary arthrodesis (P = 0.04). Rates of hardware removal were 43.6% (292/670) for ORIF and 18.4% (39/212) for arthrodesis (P < 0.001). Furthermore, 2.5% (17/670) patients in the ORIF group progressed to arthrodesis at a mean of 308 days, average cost of care associated with this group of patients was $9505.12.DiscussionPrimary arthrodesis is both significantly more expensive and has a higher complication rate than ORIF. Open reduction and internal fixation demonstrated a low rate of progression to arthrodesis, although there was a high rate of hardware removal, which may represent a planned second procedure in the management of a substantial number of patients treated with ORIF.Level of evidence:Level III Retrospective Cohort Study.     

Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation

Fracture-dislocations of the tarsometatarsal (Lisfranc) joints are frequently overlooked or misdiagnosed at initial presentation. This is a comparative cohort study over a period of five years comparing primary open reduction and internal fixation in 22 patients (23 feet) with secondary corrective arthrodesis in 22 patients (22 feet) who presented with painful malunion at a mean of 22 months (1.5 to 45) after injury. In the first group primary treatment by open reduction and internal fixation for eight weeks with Kirschner-wires or screws was undertaken, in the second group treatment was by secondary corrective arthrodesis. There was one deep infection in the first group. In the delayed group there was one complete and one partial nonunion. In each group 20 patients were available for follow-up at a mean of 36 months (24 to 89) after operation. The mean American Orthopaedic Foot and Ankle Society midfoot score was 81.4 (62 to 100) after primary treatment and 71.8 (35 to 88) after corrective arthrodesis (t-test; p = 0.031). We conclude that primary treatment by open reduction and internal fixation of tarsometatarsal fracture-dislocations leads to improved functional results, earlier return to work and greater patient satisfaction than secondary corrective arthrodesis, which remains a useful salvage procedure providing significant relief of pain and improvement in function.     

Meta-Analysis: Functional Outcome of ORIF Versus Primary Subtalar Arthrodesis of Sanders Type II and Type III Calcaneal Fractures

The choice of treatment for Sanders Type II and Type III calcaneal fractures remains controversial with unclear patient functional outcomes. A meta-analysis was done to compare the functional outcome of ORIF vs primary subtalar arthrodesis (PSA) according to American Orthopedic Foot and Ankle Score (AOFAS) hindfoot-ankle scores. The PubMed, Embase, and Cochrane Library Databases were searched by two independent evaluators. Fourteen studies met the eligible criteria. ORIF of 501 Type II and Type III fractures was compared to primary subtalar arthrodesis treatment of 57 Type II and Type III fractures. AOFAS for a mixed ORIF group of “Type II and III” fractures was 82.16 ± 1.58 at average follow-up of 25.3 months. For a mixed PSA group of “Type II and III” fractures, the AOFAS was 74.22 ± 2.45 at average follow-up of 28.0 months. This showed a difference between ORIF and primary subtalar arthrodesis of 7.94 points (95% confidence interval [CI] = 7.75–7.98; p value .004) favoring ORIF when adjusting for minimally invasive and percutaneous methods. Without adjustment, there was a difference of 6.54 points favoring ORIF (95% CI = 6.22–6.46; p value .017). In conclusion, while high-quality randomized controlled trials comparing ORIF to primary subtalar arthrodesis for Type II and Type III fractures would further elucidate superior treatment outcomes, this meta-analysis of available data shows a tendency for ORIF of Type II and Type III Sanders calcaneal fractures to have a better functional outcome at approximately 2 years postoperatively compared to primary subtalar arthrodesis.     

手术治疗Lisfranc骨折脱位临床体会

目的探讨切开复位内固定治疗Lisfranc骨折脱位的临床经验。方法自2001年3月至2009年3月,我科对37例Lisfranc骨折脱位患者切开复位皮质骨螺钉配合克氏针内固定治疗。其中男25例,女12例,年龄17～61岁;新鲜损伤33例,陈旧损伤4例。结果37例获得随访,随访时间24-49个月,平均28个月。采用美国矫形足踝协会的评分标准进行评价,好24例,较好11例,差2例。结论对于Lisfranc骨折脱位应手术治疗,解剖复位和坚强内固定是获得良好疗效的必要条件,陈旧性损伤应行关节融合术。     

Ankle fusion for definitive management of non-reconstructable pilon fractures

BACKGROUND: Highly comminuted pilon fractures, especially with a compromised soft tissue envelope, present a challenging treatment scenario. This study presents our results for patients managed with ankle fusion rather than ORIF. MATERIALS AND METHODS: Fourteen patients with ankle joint incongruence after non-reconstructable tibia pilon fractures were treated with primary tibiotalar arthrodesis using a fixed-angle cannulated blade plate. Delayed metaphyseal unions due to bone defects were treated concurrently. The subtalar joint was preserved in all cases. RESULTS: Metaphyseal healing and stable arthrodesis was obtained in each case. There was one case of blade plate breakage in a patient who still achieved successful arthrodesis without reoperation. Union was achieved at an average of 15 weeks. No secondary procedures were required to obtain union. All 14 patients were ambulatory at last followup. Average followup was 39 weeks. CONCLUSION: Primary ankle arthrodesis can be achieved using a cannulated blade plate to address a non-reconstructable articular surface and metaphyseal bone defects in complex tibia pilon fractures.     

Operatively Treated Talus Fractures: Complications and Survivorship in a Large Patient Sample

Talus fractures are relatively uncommon; however, the sequelae of talus fractures can cause significant morbidity. Although avascular necrosis has been a consistently reported complication, the reported rates of subsequent arthrodesis have varied widely. The purpose of the present study was to report the complications in a large patient sample of operatively treated talus fractures and to describe the survivorship of open reduction internal fixation (ORIF) of the talus. Patients undergoing talus ORIF for closed or open fractures from 2007 to 2011 were identified in the United Healthcare System database by International Classification of Diseases, 9th revision, code 825.21 and Current Procedural Terminology codes 28445, 28436, and 28430. Patients with a nonoperative talus fracture or isolated osteochondral defect were excluded, leaving 1527 patients in the final analysis. We also identified patients who had required subsequent subtalar, pantalar, and tibiotalocalcaneal arthrodeses using Current Procedural Terminology codes 28725, 28705, and 28715, respectively. Complications and demographic data were recorded. Of the 1527 patients, 29 (1.9%) had undergone subsequent arthrodesis within 4 years; 64 patients (4.2%) developed wound complications that did not require surgical intervention, 11 patients (0.7%) were readmitted, 204 (13.3%) presented to the emergency department (ED), and 96 (6.3%) underwent operative irrigation and debridement (I&D). The overall complication rate was 19.5%. Patients aged >34 years had a significantly greater rate of ED visits (54.7%, p?=?.015) and overall complications (56.8%, p?<?.001). In conclusion, ORIF of talus fractures has good survivorship when considering the failure of initial surgery or the requirement for secondary arthrodesis. Medical complications and hospital readmission were relatively rare; however, ED visits and infection requiring I&D were relatively common after ORIF of talus fractures.     

Is It Worth Discriminating Against Patients Who Smoke? A Systematic Literature Review on the Effects of Tobacco Use in Foot and Ankle Surgery

Although numerous studies have linked smoking with lower extremity wound and bone healing complications, a comprehensive study on the effects of smoking in foot and ankle surgery has not yet been reported. The purpose of the present study was to report the results of our systemic literature review, identifying the effects of tobacco use on common foot and ankle procedures. The systematic literature review was performed according to guidelines set by the PRIMSA statement (Preferred Reporting Items for Systematic Review and Meta-Analyses). Smoking, as a single risk factor, was analyzed and used to compare adverse outcomes in the postoperative setting of foot and ankle surgery. We reviewed 528 abstracts that met our initial identification criteria. After an extensive review process, 46 of the articles (8.71%) met the eligibility requirements to be included in the present study. Distal bunionectomy with osteotomy, first metatarsophalangeal joint arthrodesis, Lapidus bunionectomy, toe amputation, transmetatarsal amputation, Syme's amputation, open reduction internal fixation (ORIF) of calcaneal fractures, ankle fracture ORIF, pilon fracture ORIF, subtalar arthrodesis, rearfoot arthrodesis, tibiocalcaneal arthrodesis, ankle arthrodesis, total ankle arthroplasty, and plastic surgery procedures and their respective negative association with smoking was identified and described in our review. Our systematic literature review revealed that procedures involving arthrodesis, fracture ORIF, and plastic surgery were associated with negative outcomes in smokers. Procedures that did not involve osseous unions such as total ankle arthroplasty and amputations did not appear to have negative outcomes associated with smoking.     

Outcome following osteosynthesis or primary arthrodesis of calcaneal fractures: A cross-sectional cohort study

BackgroundCalcaneal fractures are uncommon and have a substantial impact on hindfoot function and quality of life. Several surgical treatment options are available; both in surgical approach and type of operation. The aim of this study was to compare functional outcome and quality of life following ORIF and primary arthrodesis. Furthermore, predictors of worse functional outcome were explored.MethodsA retrospective cross-sectional cohort study was performed in patients with surgical fixation of a calcaneal fracture with a minimum follow-up of 18 months. Patients received ORIF through the 1) Extended Lateral Approach (ELA), 2) Sinus Tarsi Approach (STA) or 3) primary arthrodesis via STA. Participants were presented a questionnaire containing demographics, the AOFAS hindfoot scale, Foot Function Index, SF-36, EQ-5D and patient satisfaction.ResultsIn total 95 patients participated in this study. The three groups were comparable regarding patient characteristics. A median score of 74.5 points on the AOFAS hindfoot scale and 11.9 on the FFI was found for the entire group. There were no statistically significant differences between patients with ORIF of primary arthrodesis. Patients scored a median of 49.0 on the Physical Component Scale of the SF-36 and 55.4 on the Mental Component Scale. On the EQ-5D patients scored a median of 0.8 points. Again no statistically significant differences were observed between the three subgroups. Socio-economic status was the only statistically significant predictor of worse functional outcome (β: 4.06, 95% CI: 0.50–7.62) after multivariable analysis.InterpretationGood midterm outcomes following in terms of functional outcome and in quality of life are observed. We observed no statistical significant difference in functional outcome between patients with ORIF and patients with primary arthrodesis. The only predictor of worse functional outcome is a lower socio-economic status.     

Open Reduction and Internal Fixation Versus Primary Arthrodesis for the Treatment of Acute Lisfranc Injuries: A Systematic Review and Meta-analysis

This study aims to compare outcomes of open reduction and internal fixation (ORIF) and primary arthrodesis in management of Lisfranc injuries. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, a systematic review was carried out. MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched to identify both randomised controlled trials (RCTs) and nonrandomised studies comparing the outcomes of ORIF and primary arthrodesis for Lisfranc injuries. Random- and fixed-effect statistical models were applied to calculate the pooled outcome data. Two RCTs and 3 observational studies were identified, compiling a total of 187 subjects with acute Lisfranc injuries and a mean follow-up duration of 62.3 months. Our results demonstrate that ORIF is associated with a significantly higher need for revision surgery (odds ratio [OR] 6.37, 95% confidence interval [CI] 2.68 to 15.11, p < .0001) and a significantly higher rate of persistent pain (OR 6.29, 95% CI 1.07 to 36.89, p?=?.04) compared with primary arthrodesis. However, we found no significant difference between the groups in terms of visual analogue scale pain score, American Orthopaedic Foot & Ankle Society functional score, or rates of infection. Separate analysis of RCTs showed that ORIF was associated with a more frequent need for revision surgery (OR 17.56, 95% CI 5.47 to 56.38, p < .00001), higher visual analogue scale pain score (mean difference 2.90, 95% CI 2.84 to 2.96, p < .00001), and lower American Orthopaedic Foot & Ankle Society score (mean difference –29.80, 95% CI –39.82 to –19.78, p < .00001). The results of the current study suggest that primary arthrodesis may be associated with better pain and functional outcomes and lower need for revision surgery compared with ORIF. The available evidence is limited and is not adequately robust to make explicit conclusions. The current literature requires high-quality and adequately powered RCTs.