Functional Outcome of Lisfranc Injuries and its Clinical & Radiological Predictors: A Prospective, Hospital Based, Observational Study
Authors/Creators
- 1. Associate Professor, Department of Orthopaedics, Karuna Medical College, Chittur, Palakkad, Kerala, India, 678103
- 2. Associate Professor, Department of Orthopaedics, ESI Hospital, Rajajinagar, Bangalore, India, 560010
- 3. Assistant Professor, Department of Orthopaedics, MES Medical College Hospital, Palachode, Perinthalmanna, Kolathur, Kerala, India, 679321
- 4. Assistant Professor, Department of Orthopaedics, Karpagam faculty of Medical Science & Research, Coimbatore, India, 641032
Description
Background and Objectives: A condition characterized by the misalignment of one or more metatarsals in relation to the tarsus is commonly known as a “Lisfranc injury.” In order to provide appropriate treatment and mitigate potential long-term repercussions, it is imperative to promptly and accurately diagnose these injuries. The primary objective of this study was to assess the clinical and radiological factors that influence the functional outcomes of different fixation techniques for treating Lisfranc fracture dislocations, as measured by the American Orthopaedic Foot and Ankle Society (AOFAS) score. Material and Methods: The research was carried out as a prospective observational study at the Department of Orthopaedics, Government Medical College and Hospital in southern India. A total of 27 patients, aged between 18 and 70 years, who had undergone surgical fixation for lisfranc injury, were included in this study. The patients were followed up both clinically and by the use of follow-up x-rays. Prior to the study, approval was obtained from the institutional ethics committee, and all participants provided informed written consent. Outcome measures: The assessment of functional outcome was conducted on the AOFAS midfoot scale. The radiological assessment was conducted by evaluating many factors, including the extent of reduction, diastasis, and adherence to the Myerson criteria, using follow-up X-ray examinations. Results: The majority of patients, namely 19 individuals (70.3%), presented with a closed Lisfranc injury, whereas just 8 patients (29.6%) exhibited an open Lisfranc injury. Among the cohort of 27 patients, a total of 2 individuals received conservative treatment. Out of the 25 Lisfranc injuries that underwent surgical treatment, 14 patients (51.8%) experienced open reduction and internal fixation (ORIF) using K-wires. Additionally, 10 patients (37%) underwent fixation with screws, while 1 patient (4%) received dorsal plate fixation. Seventeen patients (68%) had satisfactory anatomical reduction, and this outcome was shown to be significantly correlated with improved functional outcome scores (p=0.004). The study observed that the functional outcome, as assessed by AOFAS mid-foot score, demonstrated outstanding results (95-100) in 5 instances (18.5%), good results (75-94) in 17 cases (63%), and fair results (50-74) in 5 cases (18.5%). No significant associations were seen between the cause of injury, related injuries, gender of the patient, and Myerson classification groups and the AOFAS midfoot score (p>0.05). Patients with closed Lisfranc injuries exhibited statistically significant improvements in AOFAS scores compared to those with open Lisfranc injuries (p=0.024). A statistically significant correlation was seen between the various treatment methods (K-wire, Screws, Plate, Conservative) & the AOFAS scores (p=0.042). The study observed that patients with diastasis less than 2mm & post-operative tarso-metatarsal sag less than 15 degrees on lateral view had superior functional results, as shown by the AOFAS score (p=0.036 and 0.007, respectively). Screw fixation demonstrates superior efficacy in producing a diastasis of less than 2mm when compared with K-wire and plate fixation, as indicated by a statistically significant p-value of 0.032. Conclusion: The current study demonstrates that screw fixation for achieving stable anatomical reduction is more effective than K-wire and plate fixation in restoring medial cuneiform-2nd metatarsal diastasis to less than 2mm and tarso-metatarsal sagittal angle to less than 15 degrees. These radiological outcomes are crucial in the treatment of Lisfranc injury. Patients who have restoration of both radiological and functional criteria have favorable outcomes, including improved AOFAS mid-foot scores and reduced likelihood of experiencing postoperative pain and arthritis. Additional biomechanical investigations and clinical trials, encompassing a sufficient number of participants, are necessary in order to assess the efficacy and reliability of screws as a therapy modality for Lisfranc injuries.
Abstract (English)
Background and Objectives: A condition characterized by the misalignment of one or more metatarsals in relation to the tarsus is commonly known as a “Lisfranc injury.” In order to provide appropriate treatment and mitigate potential long-term repercussions, it is imperative to promptly and accurately diagnose these injuries. The primary objective of this study was to assess the clinical and radiological factors that influence the functional outcomes of different fixation techniques for treating Lisfranc fracture dislocations, as measured by the American Orthopaedic Foot and Ankle Society (AOFAS) score. Material and Methods: The research was carried out as a prospective observational study at the Department of Orthopaedics, Government Medical College and Hospital in southern India. A total of 27 patients, aged between 18 and 70 years, who had undergone surgical fixation for lisfranc injury, were included in this study. The patients were followed up both clinically and by the use of follow-up x-rays. Prior to the study, approval was obtained from the institutional ethics committee, and all participants provided informed written consent. Outcome measures: The assessment of functional outcome was conducted on the AOFAS midfoot scale. The radiological assessment was conducted by evaluating many factors, including the extent of reduction, diastasis, and adherence to the Myerson criteria, using follow-up X-ray examinations. Results: The majority of patients, namely 19 individuals (70.3%), presented with a closed Lisfranc injury, whereas just 8 patients (29.6%) exhibited an open Lisfranc injury. Among the cohort of 27 patients, a total of 2 individuals received conservative treatment. Out of the 25 Lisfranc injuries that underwent surgical treatment, 14 patients (51.8%) experienced open reduction and internal fixation (ORIF) using K-wires. Additionally, 10 patients (37%) underwent fixation with screws, while 1 patient (4%) received dorsal plate fixation. Seventeen patients (68%) had satisfactory anatomical reduction, and this outcome was shown to be significantly correlated with improved functional outcome scores (p=0.004). The study observed that the functional outcome, as assessed by AOFAS mid-foot score, demonstrated outstanding results (95-100) in 5 instances (18.5%), good results (75-94) in 17 cases (63%), and fair results (50-74) in 5 cases (18.5%). No significant associations were seen between the cause of injury, related injuries, gender of the patient, and Myerson classification groups and the AOFAS midfoot score (p>0.05). Patients with closed Lisfranc injuries exhibited statistically significant improvements in AOFAS scores compared to those with open Lisfranc injuries (p=0.024). A statistically significant correlation was seen between the various treatment methods (K-wire, Screws, Plate, Conservative) & the AOFAS scores (p=0.042). The study observed that patients with diastasis less than 2mm & post-operative tarso-metatarsal sag less than 15 degrees on lateral view had superior functional results, as shown by the AOFAS score (p=0.036 and 0.007, respectively). Screw fixation demonstrates superior efficacy in producing a diastasis of less than 2mm when compared with K-wire and plate fixation, as indicated by a statistically significant p-value of 0.032. Conclusion: The current study demonstrates that screw fixation for achieving stable anatomical reduction is more effective than K-wire and plate fixation in restoring medial cuneiform-2nd metatarsal diastasis to less than 2mm and tarso-metatarsal sagittal angle to less than 15 degrees. These radiological outcomes are crucial in the treatment of Lisfranc injury. Patients who have restoration of both radiological and functional criteria have favorable outcomes, including improved AOFAS mid-foot scores and reduced likelihood of experiencing postoperative pain and arthritis. Additional biomechanical investigations and clinical trials, encompassing a sufficient number of participants, are necessary in order to assess the efficacy and reliability of screws as a therapy modality for Lisfranc injuries.
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IJTPR,Vol13,Issue12,Article25.pdf
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Additional details
Dates
- Accepted
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2023-11-30
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References
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