Margaret A Sinkler, Alex Benedick, Michael Kavanagh, Heather A Vallier
{"title":"Functional Outcomes After High-Energy Lisfranc Injuries.","authors":"Margaret A Sinkler, Alex Benedick, Michael Kavanagh, Heather A Vallier","doi":"10.1177/10711007231181121","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Midfoot fractures and dislocations are infrequent and functional outcomes following Lisfranc injuries have not been well described. The purpose of this project was to explore functional outcomes following operative treatment of high-energy Lisfranc injury.</p><p><strong>Methods: </strong>A retrospective cohort of 46 adults with tarsometatarsal fractures and dislocations treated at a single Level 1 trauma center were reviewed. Demographic, medical, social, and injury features of these patients and their injuries were recorded. Foot Function Index (FFI) and Short Musculoskeletal Function Assessment (SMFA) surveys were collected after mean 8.7 years' follow-up. Multiple linear regression was performed to identify independent predictors of outcome.</p><p><strong>Results: </strong>Forty-six patients with mean age 39.7 years completed functional outcome surveys. Mean SMFA scores were 29.3 (dysfunction) and 32.6 (bothersome). Mean FFI scores were 43.1 (pain), 43.0 (disability), and 21.7 (activity), with a mean total score of 35.9. FFI pain scores were worse than published values for fractures of the plafond (33, <i>P</i> = .04), distal tibia (33, <i>P</i> = .04), and talus (25.3, <i>P</i> = .001). Lisfranc injury patients reported worse disability (43.0 vs 29, <i>P</i> = .008) and total FFI scores (35.9 vs 26, <i>P</i> = .02) compared with distal tibia fractures. Tobacco smoking was an independent predictor of worse FFI (<i>P</i> < .05) and SMFA emotion and bothersome scores (<i>P</i> < .04). Chronic renal disease was a predictor of worse FFI disability (<i>P</i> = .04) and SMFA subcategory scores (<i>P</i> < .04). Male sex was associated with better scores in all SMFA categories (<i>P</i> < .04). Age, obesity, or open injury did not affect functional outcomes.</p><p><strong>Conclusion: </strong>Patients reported worse pain by FFI after Lisfranc injury compared to other injuries about the foot and ankle. Tobacco smoking, female sex, and preexisting chronic renal disease are predictive of worse functional outcome scores, warranting further study in a larger sample, as well as counseling of long-term consequences of this injury.</p><p><strong>Level of evidence: </strong>Level IV, retrospective, prognostic.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":" ","pages":"960-967"},"PeriodicalIF":2.4000,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Foot & Ankle International","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10711007231181121","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/6/21 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 1
Abstract
Background: Midfoot fractures and dislocations are infrequent and functional outcomes following Lisfranc injuries have not been well described. The purpose of this project was to explore functional outcomes following operative treatment of high-energy Lisfranc injury.
Methods: A retrospective cohort of 46 adults with tarsometatarsal fractures and dislocations treated at a single Level 1 trauma center were reviewed. Demographic, medical, social, and injury features of these patients and their injuries were recorded. Foot Function Index (FFI) and Short Musculoskeletal Function Assessment (SMFA) surveys were collected after mean 8.7 years' follow-up. Multiple linear regression was performed to identify independent predictors of outcome.
Results: Forty-six patients with mean age 39.7 years completed functional outcome surveys. Mean SMFA scores were 29.3 (dysfunction) and 32.6 (bothersome). Mean FFI scores were 43.1 (pain), 43.0 (disability), and 21.7 (activity), with a mean total score of 35.9. FFI pain scores were worse than published values for fractures of the plafond (33, P = .04), distal tibia (33, P = .04), and talus (25.3, P = .001). Lisfranc injury patients reported worse disability (43.0 vs 29, P = .008) and total FFI scores (35.9 vs 26, P = .02) compared with distal tibia fractures. Tobacco smoking was an independent predictor of worse FFI (P < .05) and SMFA emotion and bothersome scores (P < .04). Chronic renal disease was a predictor of worse FFI disability (P = .04) and SMFA subcategory scores (P < .04). Male sex was associated with better scores in all SMFA categories (P < .04). Age, obesity, or open injury did not affect functional outcomes.
Conclusion: Patients reported worse pain by FFI after Lisfranc injury compared to other injuries about the foot and ankle. Tobacco smoking, female sex, and preexisting chronic renal disease are predictive of worse functional outcome scores, warranting further study in a larger sample, as well as counseling of long-term consequences of this injury.
Level of evidence: Level IV, retrospective, prognostic.
背景：中足骨折和脱位并不常见，Lisfranc损伤后的功能结果也没有得到很好的描述。该项目的目的是探索高能Lisfranc损伤手术治疗后的功能结果。方法：对46例在一级创伤中心接受治疗的成人跗骨跖骨骨折脱位进行回顾性队列研究。记录这些患者的人口学、医学、社会和损伤特征及其损伤情况。足部功能指数（FFI）和短肌肉骨骼功能评估（SMFA）调查在平均值8.7之后收集 多年的随访。进行多元线性回归以确定结果的独立预测因素。结果：46名患者，平均年龄39.7岁 年完成的功能性成果调查。SMFA平均得分分别为29.3（功能障碍）和32.6（麻烦）。平均FFI得分为43.1（疼痛）、43.0（残疾）和21.7（活动），平均总分为35.9。FFI疼痛评分低于公布的掌侧骨折评分（33，P = .04），胫骨远端（33，P = .04）和距骨（25.3，P = .001）。Lisfranc损伤患者的残疾更严重（43.0 vs 29，P = .008）和外国金融机构总分（35.9 vs 26，P = .02）与胫骨远端骨折比较。吸烟是FFI恶化的独立预测因素（P P P = .04）和SMFA子类别得分（P P 结论：与其他足部和脚踝损伤相比，Lisfranc损伤后患者的FFI疼痛更严重。吸烟、女性和先前存在的慢性肾脏疾病可以预测更差的功能结果评分，这需要在更大的样本中进行进一步的研究，并对这种损伤的长期后果进行咨询。证据级别：IV级，回顾性，预后。
期刊介绍：
Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers.
The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008.
The journal focuses on the following areas of interest:
• Surgery
• Wound care
• Bone healing
• Pain management
• In-office orthotic systems
• Diabetes
• Sports medicine
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