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Category: Volume 06 Issue 10 October 2018
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Title: A Prospective Study on Functional Outcome of Various Modalities of Treatment of Midfoot Injuries

Authors: Dr J.Kumaran, Dr R.Neelakrishnan, Dr V. Barathi Selvan, Dr P. Anush Rao

 DOI: https://dx.doi.org/10.18535/jmscr/v6i10.217

Abstract

Introduction: Midfoot injuries are highly uncommon injuries, often due to high-energy trauma. The purpose of the study is to evaluate the functional outcomes of various modalities of treatment of midfoot injuries.

Methods: Prospective single centre study, conducted for a period of 24 months in a rural secondary level hospital, which included 40 patients aged between 18 and 62 years, with midfoot injuries. Final outcome analysis included demographic, injury and treatment characteristics.

Results: Forty patients with 40 midfoot injuries were included. The majority of patients suffered high-energy trauma. Mean AOFAS score among patients treated by operative methods was 68.5 while in those treated conservatively was 78.8.Mean AOFAS score among patients with Lisfranc joint injuries was 67.6 while in those with tarsal bone injuries was 74.2. Mean AOFAS score was 72.22 (Range 51 – 85). Primary arthrodesis was performed in neglected injuries. Concomitant injuries were associated with poorer functional outcome. Superficial skin infection, Screw breakage (Implant Failure), Post traumatic arthritis and flat foot were the post operative complications encountered.

Conclusions: Injuries of the midfoot have mid- to long-term effects on quality of life after trauma. Restoration of anatomic configuration is the cornerstone of treating midfoot injuries and is the most important factor in predicting the functional outcome of these patients.

Keywords: Midfoot, Lisfranc, Tarsal Bone, AOFAS midfoot score, functional outcome.

References

  1. Probst C., Richter M, Lefering R, Frink M, Gaulke R, Krettek C, et al. Incidence and significance of injuries to the foot and ankle in polytrauma patients-an analysis of the trauma registry of DGU. Injury 2010; 41:210–5, doi: http://dx.org/10.1016/j. injury. 2009.10.009.
  2. Tran T, Thordarson D. Functional outcome of multiply injured patients with associated foot injury. Foot Ankle Int 2002; 23:340–3, doi: http: //dx.doi.org/1177/1071 10070202300409.
  3. Benirschke SK, Meinberg E, Anderson SA, Jones CB, Cole PA. Fractures and dislocations of the midfoot: Lisfranc Joint and Tarsal Bones injuries. J Bone Jt Surg - Ser A 2012; 94:1326–37, doi:http://dx.doi.org/ 10.2106/jbjs. l00413.
  4. Van Dorp Kb, De Vries Mr, Van Der Elst M, Schepers T. Tarsal Bones Joint Injury: A study of outcome and morbidity. J Foot Ankle Surg 2010;49:541–5, doi: http://doi.org/ 10.1053/j.jfas.2010.08.005.
  5. Sheibani-Rad S, Coetzee JC, Giveans MR, DiGiovanni C. Arthrodesis versus ORIF for Lisfranc Joint fractures. Orthopedics 2012;35:e868–73, doi:http://dx.doi.org/3928/ 01477447-20120525-26.
  6. Henning JA, Jones CB, Sietsema DL, Bohay DR, Anderson JG. Open reduction internal fixation versus primary arthrodesis for Lisfranc Joint injuries: a prospective randomized study. Foot Ankle Int/Am Orthop Foot Ankle Soc [and] Swiss Foot Ankle Soc 2009;30:913–22, doi:http: //dx.doi.org/ 10.3113 /FAI.2009.0913.
  7. Abbasian MR, Paradies F, Weber M, Krause F. Temporary internal fixation for ligamentous and osseous Lisfranc Joint injuries. Foot Ankle Int 2015;36:976–83, doi: http://dx.doi.org/ 10.1177/1071100715577787.
  8. Coetzee JC, Ly TV. Treatment of primarily ligamentous Lisfranc Joint joint injuries: primary arthrodesis compared with open reduction and internal fi Surgical technique. J Bone Jt Surg Am 2007;89(Pt 1 Su):122–7, doi:http://dx. doi.org/ 10.2106/ JBJS.F.01004.
  9. Kösters C, Bockholt S, Müller C, Winter C, Rosenbaum D, Raschke MJ, et al. Comparing the outcomes between Tarsal Bones, Lisfranc Joint and multiple metatarsal shaft fractures. Arch Orthop Trauma Surg 2014;134:1397–404, doi:http://dx.org/10. 1007/s00402-014-2059-8.
  10. Leenen LPH, Van Der Werken C. Fracture-dislocations of the tarsometatarsal joint, a combined anatomical and computed tomographic study. Injury 1992;23:51–5, doi:http: //dx.doi.org/ 10.1016/0020-1383(92) 90127-E.
  11. Richter M, Wippermann B, Krettek C, Schratt HE, Hufner T, Thermann H. Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results. Foot Ankle Int 2001;22:392–8, doi:http://dx.doi.org/1177/1071 10070102200506.
  12. The American College of Surgeons. Advanced trauma life support (ATLS1): the ninth edition. J Trauma Acute Care Surg 2013;1–392, doi:http://dx.doi.org/1097/TA.0b013e 31828b82f5.
  13. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, Hallux, and Lesser toes. Foot Ankle Int 1994;15:349–53, doi:http://dx.doi.org/ 10.1177/ 1071100794015 00701.
  14. Rabin R, Charro FDe. EQ-5D: a measure of health status from the EuroQol Ann Med 2001;33:337–43, doi:http://dx.doi.org/ 10.3109/ 07853890109 002087.
  15. Van Reenen M, Janssen B. Eq-5d-5l User Guide - Basic Information On How To use the EQ-5D-5L instrument. Version 21. . p. 22.
  16. Hoeymans N, Van Lindert H, Westert GP. The health status of the Dutch population as assessed by the EQ-6D. Qual Life Res 2005;14:655–63, doi: http://dx.doi.org/10.1007/ s11136-004-1214-z.
  17. Versteegh MM, Vermeulen KM, Evers SM, de Wit GA, Prenger R, Stolk EA. Dutch tariff for the five-level version of EQ-5D. Value Heal 2016;19:343–52, doi:http://dx.doi.org/10.1016/j.jval.2016.01.003.
  18. Gunning A, van Heijl M, van Wessem K, Leenen L. The association of patient and trauma characteristics with the health-related quality of life in a Dutch trauma population. Scand J Trauma Resusc Emerg Med 2017;25:, doi:http://dx.org/10. 1186/s 13049-017-0375-z.
  19. Frink M, Geerling J, Hildebrand F, Knobloch K, Zech S, Droste P, et al. Etiology, treatment and long-term results of isolated midfoot fractures. Foot Ankle Surg 2006;12:121–5, doi:http://dx.doi.org/ 10.1016/j.fas.2006.02.004.
  20. Kuo RS, Tejwani NC, DiGiovanni CW, Holt SK, Benirschke SK, Hansen ST, et al. Outcome after open reduction and internal fixation of Lisfranc Joint joint injuries. J Bone Jt Surg 2000;82(A):1609–18.
  21. Hollman EJ, van der Vliet QMJ, Alexandridis G, Hietbrink F, Leenen LPH. Functional outcomes and quality of life in patients with subtalar arthrodesis for posttraumatic arthritis. Injury 2017;48:1696–700, doi:http: //dx.doi.org/ 1016/j. injury. 2017.05.018.
  22. Richter M, Thermann H, Huefner T, Schmidt U, Goesling T, Krettek C. Tarsal Bones joint fracture-dislocation: initial open reduction provides better outcome than closed reduction. Foot Ankle Int 2004;25:340–8 doi:604507 [pii].
  23. Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, et al. Operative compared  with  nonoperative  treatment  of  displaced  intra- articular  calcaneal  fractures:  a  prospective,  randomized,  controlled multicenter trial. J Bone Jt Surg Am 2002;84–A:1733–44, doi:http://dx.doi. org/10.1055/s-0028-1100885.
  24. Alexandridis G, Gunning AC, Leenen LPH. Patient-reported health-related quality of life after a displaced intra-articular calcaneal fracture: a systematic World J Emerg Surg 2015;10(62), doi:http: //dx.doi.org/ 10.1186/ s13017-015-0056-z.
  25. Zelle BA, Brown SR, Panzica M, Lohse R, Sittaro NA, Krettek C, et al. The impact of injuries below the knee joint on the long-term functional outcome following polytrauma. Injury 2005;36:169–77, doi:http://dx.doi.org/10.1016/j. 2004.06.004.
  26. Alexandridis G, Gunning a C, Leenen LPH. Health-related quality of life in trauma patients who sustained a calcaneal fracture. Injury 2016; 47:1586–91, doi:http:// dx.doi. org/10.1016 /j.injury.2016.04.008.
  27. Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. Br Med J 2014;349: g4483, doi:http:// dx.doi.org/10.1136/bmj.g4483.
  28. De Boer AS, Van Lieshout EMM, Den Hartog D, Weerts B, et al. Functional outcome and patient satisfaction after displaced intra-articular calcaneal fractures: a comparison among open, percutaneous,  and  nonoperative J Foot Ankle Surg 2015; 54: 298–305, doi:http:// dx.doi.org/ 10.1053/  j.jfas.2014.04.014.
  29. Mulier T, Reynders P, Dereymaeker G, Broos P. Severe Lisfranc Joints injuries: primary arthrodesis or ORIF? Foot Ankle Int 2002;23:902–5, doi:http://dx.doi. org/10.1177/10711 0070202301003.
  30. Reinhardt KR, Oh LS, Schottel P, Roberts MM, Levine D. Treatment of Lisfranc Joint fracture-dislocations with primary partial arthrodesis. Foot Ankle Int 2012;33:50–6, doi:http:// dx.doi.org/ 10.3113/FAI.2012.0050.

Corresponding Author

Dr V. Barathiselvan

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