The Clinical Effect Of Three Column Reconstruction With Internal Fixation In The Treatment Of Lisfranc Injury

ObjectiveComparative analysis of Kirschner wire,hollow screw and miniature plate are applied to fix and reconstrut of three column for treatment Lisfranc injury,which provides clinical reference and guidance on the choice of fixed way.MethodsA retrospective analysis of 52 patients with Lisfranc injury treated at Jinan military general hospital orthopedic in 2011.02-2015.06,including 33 cases of male,19 cases of female;age range from 17 to 68 years old,(34.2±11.35)years old on average;35 cases on left side,17 cases on right side.According to the Hardcastle parting,type A 22 cases,type B 16 cases,type C 14 cases.Choose Kirschner wire(group A),hollow screw(group B)and miniature plate(group C)respectively to accomplish operation with the three different internal fixation devices.The Kirschner wire group contains 18 cases,including,type A 5 cases,type B 7 and type C 6 cases.The screw group contains 21 cases,including type A 6 cases,type B 10 cases,type C 5 cases.The miniature plate group contains 13 cases,including type A 3 cases,type B 7 cases and type C 3 cases.The Kirschner wire group?hollow screw group and miniature plate group were all treated with open reduction and internal fixation with the theory of three column reconstruction.Preoperative the affected foot was shot by normotopia?lateral and oblique position for X-ray,if necessary,by CT and 3D reconstruction,in order to clarify the fracture and dislocation.Postoperative followed up patients,applying the method of the American Orthopaedic Foot and Ankle Society(AOFAS)score standards to efficacy evaluation of group A?B and C,and observed three groups of postoperative complications.ResultsThe three groups of patients with postoperative follow-up of 4 to 11 months,postoperative AOFAS score: group A: great: 5 cases,good: 9 cases,medium: 2 cases,bad: 2 cases,fine rate was 77.8%;group B: great: 7 cases,good: 11 cases,medium: 2 cases,bad: 1case,fine rate was 85.7%;group C: great: 5 cases,good: 7 cases,medium: 1cases,fine rate was 92.3%.Through the statistical analysis,P>0.05,there was no statistically significant difference of midfoot score in three groups.Postoperative group A's needle track infection in 1 cases,1 case of patients affected foot dorsal part skin necrosis,1 cases of patients with traumatic arthritis;in group B,1 cases of patients with foot and ankle joint stiffness,plantar arch was 1 case appeared flat,1 cases of patients with traumatic arthritis.Plantar arch was 1 case in group C appeared flat,1 cases of patients with traumatic arthritis,no other complications occurred.Through the statistical analysis,P>0.05,three group's complications occurred rate was statistically significant.ConclusionsThe three column theory to guide the operation of Lisfranc injury treatment has important clinical significance,through reconstruction and anatomical reduction the three column of midfoot and firm internal fixation,restoring the normal physiological structure of plantar arch,so as to achieve the mechanical and biological balance,to provide good conditions for healing of fracture and dislocation.Open reduction and internal fixation with three column reconstruction for the treatment of Lisfranc injury,the medial column foot,middle column needs strong fixation,however lateral column requires elastic fixation.Based on the guidance of the three column theory,three kinds of internal fixation treatment of tarsometatarsal joint injury were significant results,all healing,and the influence of three internal fixation methods for prognosis has no obvious difference.