Purpose:The most popular surgical approach to manage Lisfranc fracture-dislocations is the double-incision approach,which frequently causes a variety of complications,such as skin necrosis,rotational malreduction of t...Purpose:The most popular surgical approach to manage Lisfranc fracture-dislocations is the double-incision approach,which frequently causes a variety of complications,such as skin necrosis,rotational malreduction of the first tarsometatarsal joint(TMTJ)and lateral column dorsoplantar malreduction of the TMTJ.We introduce a three-incision approach to treat Lisfranc fracture-dislocations with only minor postoperative complications and good foot function.Methods:We prospectively selected 30 previously healthy patients,ranging from 18 to 60 years of age,but only 23 patients completed the follow-up and thus were finally included,with an average age of 38.1±12.9 years.All patients have sustained Lisfranc fracture-dislocations involving all three-column;13.0%(3/23)were Myerson classification type A(medial),47.8%(11/23)were type A(lateral),and 39.1%(9/23)were type C2.All patients were treated via a three-incision approach:a long incision made along the lateral border of the second ray was used as a working incision to visualize and reduce the first three TMTJs,as well as to apply internal fixation instrumentation;a 2 cm medial incision was made at the medial side of the first TMTJ as an inspecting incision,ensuring good reduction of the first TMTJ in medial and plantar view;another 1 cm inspecting incision was made at the dorsal side of the fourth/fifth TMTJ to prevent sagittal subluxation of the lateral column.Mean±SD was used for quantitative data such as operation time,follow-up time and foot function scores.Postoperative complications were documented,and foot function was evaluated using the American orthopaedic foot&ankle society score,foot function index and Maryland foot score at follow-up.The foot function of the injured foot and contralateral foot of the same patient was at the end of follow-up,and independent samplet-test was used for statistical analysis.Results:The median operation time was 117.9±14.6 min(range 93-142 min).All complications occurred within three months after the operation,and included delayed wound healing(17.4%),superficial infection(8.7%),complex regional pain syndrome(4.3%)and neuroma(4.3%).There was no case of postoperative skin necrosis or malreduction.At the end of follow-up of 14.1±1.2 months(range 12-16 months),the median American orthopaedic foot&ankle society score of the operated foot was 89.7±5.7,the median foot function index was 21.7±9.9,and the median Maryland foot score was 88.7±4.8.There were no significant differences between the operated and contralateral sides,in terms of foot function,at the end of followup(p>0.05).Conclusion:The three-incision approach can provide adequate visualization of all TMTJs to ensure anatomical reduction and offer sufficient working space to apply internal fixation instrumentation,which is effective in treating three-column Lisfranc fracture-dislocations with minor soft tissue complications and satisfactory functional recovery.展开更多
文摘Purpose:The most popular surgical approach to manage Lisfranc fracture-dislocations is the double-incision approach,which frequently causes a variety of complications,such as skin necrosis,rotational malreduction of the first tarsometatarsal joint(TMTJ)and lateral column dorsoplantar malreduction of the TMTJ.We introduce a three-incision approach to treat Lisfranc fracture-dislocations with only minor postoperative complications and good foot function.Methods:We prospectively selected 30 previously healthy patients,ranging from 18 to 60 years of age,but only 23 patients completed the follow-up and thus were finally included,with an average age of 38.1±12.9 years.All patients have sustained Lisfranc fracture-dislocations involving all three-column;13.0%(3/23)were Myerson classification type A(medial),47.8%(11/23)were type A(lateral),and 39.1%(9/23)were type C2.All patients were treated via a three-incision approach:a long incision made along the lateral border of the second ray was used as a working incision to visualize and reduce the first three TMTJs,as well as to apply internal fixation instrumentation;a 2 cm medial incision was made at the medial side of the first TMTJ as an inspecting incision,ensuring good reduction of the first TMTJ in medial and plantar view;another 1 cm inspecting incision was made at the dorsal side of the fourth/fifth TMTJ to prevent sagittal subluxation of the lateral column.Mean±SD was used for quantitative data such as operation time,follow-up time and foot function scores.Postoperative complications were documented,and foot function was evaluated using the American orthopaedic foot&ankle society score,foot function index and Maryland foot score at follow-up.The foot function of the injured foot and contralateral foot of the same patient was at the end of follow-up,and independent samplet-test was used for statistical analysis.Results:The median operation time was 117.9±14.6 min(range 93-142 min).All complications occurred within three months after the operation,and included delayed wound healing(17.4%),superficial infection(8.7%),complex regional pain syndrome(4.3%)and neuroma(4.3%).There was no case of postoperative skin necrosis or malreduction.At the end of follow-up of 14.1±1.2 months(range 12-16 months),the median American orthopaedic foot&ankle society score of the operated foot was 89.7±5.7,the median foot function index was 21.7±9.9,and the median Maryland foot score was 88.7±4.8.There were no significant differences between the operated and contralateral sides,in terms of foot function,at the end of followup(p>0.05).Conclusion:The three-incision approach can provide adequate visualization of all TMTJs to ensure anatomical reduction and offer sufficient working space to apply internal fixation instrumentation,which is effective in treating three-column Lisfranc fracture-dislocations with minor soft tissue complications and satisfactory functional recovery.
