5 years follow up of open reduction and internal fixation of lisfranc injuries
5 years follow up of open reduction and internal fixation of lisfranc injuries
Keywords:
Lisfranc, Open reduction, AOFAS Score.Abstract
In the treatment of fracture-dislocations of the tarso-metatarsal joints, early accurate diagnosis combined with prompt anatomical reduction and stable internal fixation provides optimal results
Aims and Objectives: Open reduction and internal fixation has been recommended as the treatment for most unstableinjuries of the Lisfranc (tarso-metatarsal) joint. In many of cases Lisfranc injuries are diagnosed late or missed because of associated injuries and treated by other methods like cast application, closed reduction etc. and are associated with poor outcome.
Material and Methods:We performed a retrospective study of patients who underwent open reduction and screw fixation or k wire fixation of a Lisfranc injury in a three-year period. Among 20 adults treated for that injury, they were followed for minimum of 5 years. 5 injuries were purely ligamentous, and 15 were combined ligamentous and osseous. Patient outcome was assessed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score.
Results: The average AOFAS midfoot score was 79.8 points (on a scale of 0 to 100 points, with 100 points indicating an excellent outcome), with patients losing points for pain, decreased recreational function, and orthotic requirements. The major determinant of a good result was anatomical reduction (p = 0.05). Patients with purely ligamentous injury showed a trend toward poorer outcomes despite anatomical reduction and screw fixation/k-wire fixation.
Conclusion: This study support the concept of stable anatomical reduction of Lisfranc fracture-dislocations leads to the best long-term outcomes as patients so treated have less arthritis as well as better AOFAS midfoot scores
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