Comparative Analysis Of Surgical Treatment Of Open And Closed Lisfranc Injury

Objective: To investigate the surgical efficacy of Kirschner wire internal fixation in the treatment of open and closed Lisfranc injuries,to analyze the advantages and disadvantages of Kirschner wire internal fixation in the treatment of open and closed Lisfranc injuries,and to evaluate the postoperative clinical prognosis.In the future,clinicians will provide further reference for the treatment of Lisfranc injury.Methods: A retrospective analysis of patients with Lisfranc injuries treated in the Department of Hand and Foot Surgery of Subei People’s Hospital of Jiangsu province from January 2013 to December 2018.According to the Myerson classification commonly used in clinical practice,44 patients with Myerson type B were treated with Kirschner wire internal fixation for open and closed Lisfranc injuries,including 27 males and 17 females each,aged 13 ～ 74 years old,with an average age of(45.39 ±14.51)years.According to the method of random number table,the patients with closed and open Lisfranc injury were divided into group A and group B.In group A,22 patients with open Lisfranc injury were temporarily fixed with Kirschner wire after debridement in emergency department;in group B,22 patients with closed Lisfranc injury were treated with Kirschner wire internal fixation.The causes of injuries in group A and group B were all caused by high-energy injuries.Case inclusion criteria:(1)Lisfranc injury was diagnosed through imaging examination and clinical manifestations and had a history of trauma;(2)Open Lisfranc injury with wound larger than 5cm;(3)The history of trauma was clear and the foot activity was normal before the injury.(4)All the patients were examined by X-ray in the positive and lateral position of the weight-bearing position.After admission,they were examined by CT and MRI.;(5)The patients had no serious organ dysfunction and could tolerate surgery.(6)Kirschner wire internal fixation was selected for closed Lisfranc injury due to economic difficulties.Case exclusion criteria:(1)At the same time,patients with fractures of otherparts of the lower extremities may lead to poor functional rehabilitation exercise during the recovery period;(2)At the same time,the patients with wound infection in the adjacent area may lead to wound infection and delay the time of wound healing;(3)At the same time,patients with heart and lung diseases who can not bear the risk of surgical stress after professional assessment by anesthesiologists;(4)Patients with old Lisfranc injuries;(5)Patients who could not cooperate with follow-up after investigation and were unwilling to participate in this study.The patient’s foot,gender and age were compared and statistically analyzed to observe whether there was statistical significance between the indicators.Similarly,the data of postoperative hematoma,muscle atrophy,traumatic arthritis,nonunion of fracture and malunion and the ankle posterior foot function score standard of American Orthopaedic Foot and Ankle Society(AOFAS)were statistically analyzed,and whether there was statistical significance in each group of data difference was analyzed,and the prognosis effect of patients was evaluated.Results: 44 patients with Lisfranc injury were followed up for 12-35 months,with an average of(20.10±3.44)months.There was no significant difference between group A and group B in sex,foot and age(P > 0.05).There was no significant difference in the causes of injury between groups A and B(P> 0.05).The excellent and good rates of AOFAS in group A and group B were 68.18% and 81.81% respectively in 12 months after operation.There was no significant difference between group A and group B(P >0.05).In group A and B,there were 2 cases of fracture malunion,1 case of hematoma and 3 cases of traumatic arthritis.The total incidence of complications was 18.18% in group A and 9.09% in group B.There was no significant difference between group A and group B(P > 0.05).The average AOFAS scores before and after operation in group A and B were 37.27 ± 5.64,37.41 ± 5.43,and the average AOFAS scores after follow-up at 12 months were 79.36 ± 10.17,83.77 ± 11.55.The data of group A and group B showed that the AOFAS scores followed up at 12 months after surgery were increased to varying degrees compared with those before treatment,and the closed Lisfranc injury was higher than the open Lisfranc injury.The AOFAS scores before and after surgery were compared between the A and B groups,and the differences werestatistically significant(P <0.05).Conclusions: Kirschner wire internal fixation can maintain the stability of Lisfranc joint in patients with open and closed Lisfranc injury,and achieve bone healing after operation.The AOFAS scores of patients with open and closed Lisfranc injury treated by Kirschner wire internal fixation at the end of 12 months after operation were higher than those before operation,which could significantly improve the foot function of patients.There was no significant difference in the incidence of postoperative complications and prognosis between patients with open and closed Lisfranc injury treated with Kirschner wire internal fixation.