Clinical Efficacy Of Treating Lisfranc Injury With Different Patterns Of Internal Fixation

Background:Lisfranc joints, namely the plantar hocks, also known as plantar hocks complex,including bones, joints and ligaments of plantar hocks. The plantar hocks participate in themedial longitudinal arch of foot (the first metatarsal and the medial cuneiform bone), thelateral longitudinal arch of foot(the fifth metatarsal and the cuboid) and intermediate crossbow (the medial, intermediate and lateral cuneiform bone and the cuboid). Lisfranc jointdamage or plantar hocks fracture dislocation is a kind of generalized intra-articular injury.The misdiagnose and therapeutic error will cause traumatic arthritis and lead to affect thefunction. in1986Myerson according to fully anatomical features of Lisfranc injury putforward three column theory, the lateral column is composed of4,5metatarsal and cuboid,maximum activity; The middle column, from2,3metatarsal and the lateral wedge bone,minimal activity; The inside of the column is composed of the first metatarsal and the medialcuneiform, activity between the two. The original classification system, the foot injury weredivided into three type: type A, as the overall separation; Type B for part of the separation; Ctype for fork type separation. In1986, the Myerson after further subdivided, divided type Binto B1type, part of the separation of the medial displacement; B2type and part of theseparation of the lateral shift; and divided tupe C into C1, bifurcate separated part shift; C2,bifurcate separation integral transfer. But so far none of the classification systems is helpfulto determine treatment plan and prognosis. With the rapid development of orthopedicsinstruments, Lisfranc injury treatment towards the direction of simplification, minimallyinvasive and progress. The gold standard of Lisfranc injury treatment is anatomical reduction,stable internal fixation, and internal fixation including Kirschner wire, screw and miniatureplate. However, no matter which method of internal fixation treatment of Lisfranc injury used,the foot of postoperative complications such as traumatic arthritis and weight-bearing pain isstill high.Objective:To observe the mechanism of action of three kinds of internal fixation (Kirschner wire,screw and miniature plate) treatment of Lisfranc injury, compare the three kinds of risks and curative effect of internal fixation surgery, discusses the advantages and disadvantages ofthree kinds of internal fixation treatment with Lisfranc injury, comparison and analysis theirrespective scope of application and matters needing attention, for the treatment of Lisfrancinjury, which provides the theoretical foundation on the choice of fixed way, providereference and guidance on the operation.Methods:A retrospective analysis of55patients with Lisfranc injury treated at jilin universityChina-Japan union hospital orthopedic in2010-2014, including30cases of male,25cases offemale, according to the Myerson parting, type A22cases, type B17cases, type C16cases.Choose Kirschner wire, screw and miniature plate respectively to accomplish the threedifferent operation methods. The Kirschner wire group contains19cases, including male11cases and female8cases, type A14cases and type C5cases. The screw group contains22cases, including male10cases, female12cases, type A6cases, type B11cases, type C5cases. The miniature plate group contains14cases, including male8cases, female6cases,type A2cases, type B6cases and type C6cases. The Kirschner wire group adopts closedreduction, the screw group and miniature plate group adopt open reduction. To each patient’sage, gender, and fracture classification statistical analysis, there is no significant difference.Preoperative preparation of three groups of the same and the way of anesthesia. Statisticalgroups of patients with operation time, fracture healing time, postoperative AOFAS score, thepostoperative complications such as index, data analysis, observation of each index with orwithout significant difference.Results:The three groups of patients with postoperative follow-up of4to13months, all fracturesare healed. Operation time of the Kirschner wire group is55.4+/-8.6min’s, that of thescrew group is64.5+/-11.3min, and that of the miniature plate group is77.4+/-9.8min.Comparing each group, P <0.05, the difference is statistically significant. The Kirschner wiregroup was postoperative AOFAS score group is78.6%, the screw group is86.4%, theminiature plate is92.9%, through the statistical analysis, P>0.05, there was no statisticallysignificant difference in three groups.Conclusions:The effect of three kinds of internal fixation treatment Lisfranc injury is obvious, thesuccessful healing fracture or dislocation. The operation time of Kirschner wire closedreduction and fixation is short, and the Kirschner wire is fit for patients of lighter damage and poor tolerance. The influence of three internal fixation methods for prognosis has no obviousdifference.