Injuries of the tarsometatarsal joints: treatment and outcome [Lisfrancova ozljeda]

Malović, Mario and Milošević, Milan and Vlahović, Tomislav and Nikolić, Tatjana and Margetić, Petra and Milošević, Milan (2011) Injuries of the tarsometatarsal joints: treatment and outcome [Lisfrancova ozljeda]. Collegium Antropologicum, 35 (4). pp. 1203-1208. ISSN 0350-6134

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Abstract

Between January 2005 and May 2009, a total of 26 patients, 21 males and 5 females, were admitted for treatment of Lisfranc lesion. All patients were radiologically evaluated and classified according to the criteria proposed by Myerson: 5 (19.2%) patients had a type A injury, 2 patients (7.7%) presented with a type B1 injury, 17 (65.4%) sustained the most common type B2 injury and 1 (3.8%) patient suffered from a type C1 and C2 injury. Taking radiological and clinical findings in account, fifteen patients were elected for operative treatment and eleven patients were treated conservatively. According to type of fracture we established three groups; in group I metatarsal fracture was found in fourteen (53.9%) patients, group II with phalangeal fracture in three (11.5%) cases, whereas in group III nine (34.6%) patients sustained combined metatarsal, navicular and, most commonly, a cuneiform fracture. Using the American Orthopedic Foot and Ankle Society (AOFAS) midfoot scoring scale and SF-36 questionnaire, the functional outcome was assessed. The mean value for age distribution was 42.7 +/- 13.2 years and the mean follow up was 27.9 +/- 12.4 months. A p value < 0.005 was regarded as statistically significant for the analysis of the results. We found by means of SF 36 questionnaire a statistically significant difference in the role limitation due to existence of pain (p = 0.04) and poor general health (p = 0.013) in the group of patients that sustained combined foot fracture. The purpose of this study is to assess the treatment of Lisfranc injuries in our patients, according to SF36 and AOFAS criteria, clinical outcome was evaluated. In the group I the mean AOFAS score was 74.0 +/- 9.1 and in the group II it reached 72.0 +/- 5.2 signifying fair outcome! Poor outcome was present in the group III with mean AOFAS score 67.1 +/- 9.0. All unstable injuries require surgery. Clinical outcome is highly dependent on the restoration of normal anatomic alignment.

Abstract in Croatian

U periodu između siječnja 2005. g. i svibnja 2009. g. 26 pacijenata, od toga 21 muški i 5 žena, liječeni su zbog Lisfrancove ozljede. Izvršena je klasifikacija ozljede na temelju Myersonove klasifikacije: 5 bolesnika zadobilo je ozljedu tipa A, 2 bolesnika tipa B1 a 17 njih je pretrpilo najčešći tip ozljede B2. Ozljeda tipa C bila je prisutna u samo jednom slučaju. Na temelju RTG I kliničke slike, 15 bolesnika bilo je podvrgnuto operativnom liječenju dok je ostalih jedanaest liječeno konzervativno. Uzimajući u obzir prijelome kostiju stopala, dobili smo podjelu na tri grupacije: grupa I obuhvaćala je prijelome metatarzalnih kostiju – 14 bolesnika (53,9%), grupa II prijelome falangi prstiju – 3 bolesnika (11,5%) te grupa III gdje su bile prisutne kombinirane frakture metatarzalnih kostiju, navikularnih i, najčešće, kuneiformnih kostiju. Koristeći klasifikaciju Američkog ortopedskog udruženja za kirurgiju stopala i gležnja (AOFAS) te SF-36 upitnik, procijenili smo rezultate liječenja. Prosječna dob bolesnika bila je 42,7±13,2 godina dok je prosječno praćenje iznosilo 27,9±12,4 mjeseci. U analizi rezultata korištena je p vrijednost, koja je bila statistički značajna u slučaju <0.005. Na temelju SF 36 upitnika uvidjeli smo statistički značajnu razliku u smanjenju aktivnosti bolesnika zbog postojanja boli (p=0,04) i lošeg općeg zdravlja (p=0,013) u grupi III. Svrha ovog rada bila je uvidjeti uspješnost liječenja Lisfrancove ozljede na temelju već spomenutih SF 36 i AOFAS kriterija. U grupi I prosječni AOFAS skor iznosio je 74,0±9,1 bod, u grupi II 72,0±5,2 bod što govori u prilog dobrog rezultata. Loši rezultati bili su prisutni u grupi III sa prosječnim AOFAS skorom 67,1±9,0 bod. Sve nestabilne ozljede tarzometatarzalne regije zahtijevaju operacijsko liječenje. Klinički ishod uvelike ovisi o uspostavljanju normalnih anatomskih odnosa.

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