Clinical Research Of Old Injury Of Lisfranc Joint

Objectives Providing reference for treatment methods selection of Lisfranc joint old injuries by comparing the clinical results of the two methods of Open Reduction and Internal Fixation and Arthrodesis for Lisfranc joint old injury.Methods From 2004 Oct. to 2014 Oct. in Foot and Ankle Surgery, department of orthopedics Affiliated Hospital of North China University of Science and Technology(The second hospital of Tangshan) clinical cases of patients of Lisfranc joint old injury which after surgery and got a complete follow-up were selected. 82 cases of Lisfranc joint old injury with two treating methods of internal fixation and arthrodesis were selected and the relevant medical, surgical, imaging and follow-up data were collected for retrospective statistical analysis. The cases were divided into two groups according to different surgical methods: 42 cases for open reduction and internal fixation group(Group A) and 40 cases for Lisfranc arthrodesis group(Group B). Group A including 27 males and 15 females, aged 18 to 65 years, an average of 39.10 ± 11.22(years); Group B including 28 males and 12 females, aged 19 to 61 years, an average of 38.60 ± 10.37(years). Time from injury to surgery: Group A, 3 ~ 14 w, an average of 6.37 ± 4.17(w); Group B, 3 ~ 42 w, an average of 6.83 ± 6.74(w). Preoperative midfoot functional AOFAS score: Group A, 13~62 points, anverage of 36.98 ± 11.55(points), Group B, 12~58 points, anvergae of 33.45 ± 13.30(points). To analyze damaging factors, to type the injury According to Myerson classification. Surgical approaches: The Group A patients select open reduction and cannulated screw, micro-plate system, or a hybrid fixed Kirschner while the Group B patients select open reduction, correction of deformity, Lisfranc arthrodesis, hollow screw, micro-plate system, or a mixed Kirschner fixation. After sugery Group A patients do not need external fixation or brake for 3~4w based on the specific circumstances while Group B patients all have external fixation brake for 8~12w. Group A patients begin weightbearing exercise at the 4~6w after sugry while Group B patients begin at the 12 w. All the two groups remove the outer column Kirschner at the 6~8 weeks after sugery. Group A patients were suggested to remove internal fixation while Group A patients weren't. To understand the fracture healing and complications situation by regular review, recovery of the affected foot function checking, X-ray film shooting and to records the review results. All the 82 patients have received 13 to 36 months with an average month of 19.5 months. To assess the recovery of the middle-foot function mainly according to the American Association of Foot and Ankle Foot score one year after surgery. Weight-bearing exercise time, fracture(arthrodesis) healing time, postoperative year full functional recovery excellent and good rate, talus first metatarsal angle and complications were analyzed statistically to compare the the combined effect of the two treatments.Results 1 To compare the gender, age, injury factors, injury classification, treatment time after injury, preoperative midfoot functional AOFAS score of the two groups, the difference was not statistically significant and comparable by the statistical test(P>0.05). 2 The weight-bearing exercise time, fracture(arthrodesis) healing time, internal fixation removal between the two groups were compared by statistical analysis, the difference was statistically significant(P<0.05). 3 The talus first metatarsal angle, the rate of excellence and the incidence of complications were compared by statistical analysis, the difference was not statistically significant(P>0.05).Conclusions 1 The weight-bearing exercise time, fracture healing time of Open Reduction and Internal Fixation is superior to fusion while tarsometatarsal arthrodesis taken advantage of fixation removal. 2 There is no significant difference in talus first metatarsal angle, excellent and good rate of middle-foot function and the incidence of complications between Open Reduction and Internal Fixation and arthrodesis. 3 All the two methods of operation are effective ways to treat Lisfranc joint old injury.