Epidemiología y Tratamiento de las fracturas luxaciones del mediopie

  • Cristina Montes Torres Hospital Universitario Virgen de las Nieves
  • Francisco Manuel Requena Ruiz
  • Nicolás Prados Olleta
Palabras clave: Fractura luxación Lisfranc, Fractura luxación tarsometatarsiana, tratamiento Lisfranc

Resumen

Objetivo: Análisis de las características demográficas, tipos de tratamiento quirúrgico y resultados de pacientes con lesión de Lisfranc. Material y métodos: Se recogieron los datos de 42 fracturas luxaciones de Lisfranc. Analizamos las características demográficas de nuestra serie y comparamos los resultados entre 25 pacientes intervenidos mediante reducción abierta y fijación interna (RAFI) y 17 mediante artrodesis primaria. Resultados: En relación a las características demográficas, en el 77.8 % de las mujeres el mecanismo de acción fue de baja energía, frente al 45.8% de los hombres con una relación estadísticamente significativa (p=0.037). No se encontraron diferencias estadísticamente significativas en la escala AOFAS según el mecanismo de acción, la clasificación de la lesión y el tipo de cirugía definitiva. No encontramos una diferencia estadísticamente significativa entre el tipo de tratamiento y las complicaciones con una P de 0.228. No incluimos la retirada de material protocolizada como complicación en el grupo de reducción abierta y fijación interna. Conclusiones: Las lesiones de Lisfranc producidas por mecanismos de baja energía son más frecuentes en mujeres. No se ha podido demostrar la superioridad de un tratamiento respecto a otro en relación a la tasa de complicaciones y los resultados funcionales en la escala AOFAS.

Citas

Fischer LP. Jacques Lisfranc de Saint-Martin (1787-1847). Hist Sci Med. 2005 Jan-Mar;39(1):17-34. https://www.ncbi.nlm.nih.gov/pubmed/15977358

Welck MJ, Zinchenko R, Rudge B. Lisfranc injuries. Injury 2015; 46(4): 536–41. https://doi.org/10.1016/j.injury.2014.11.026

Desmond EA, Chou LB. Current Concepts Review: Lisfranc Injuries. Foot Ankle Int. 2006; 27(8): 653-60. https://doi.org/10.1177/107110070602700819

Mulcahy H. Lisfranc Injury Current Concepts. Radiol Clin N Am 2018; 56 (6): 859-76. https://doi.org/10.1016/j.rcl.2018.06.003

Richter M, Wippermann B, Krettek C, Schratt HE, Hufner T, Therman H. Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results. Foot Ankle Int. 2001; 22(5): 392-8. https://doi.org/10.1177/107110070102200506

Crates JM F. Barber FA, Sanders EJ Subtle Lisfranc Subluxation: Results of Operative and nonoperative Treatment. Journal of Foot & Ankle Surgery, 2015;54(3): 350-5. https://doi.org/10.1053/j.jfas.2014.07.015

Ross G, Cronin R, Hauzenblas J, Juliano P: Plantar ecchymosis sign: A clinical aid to diagnosis of occult Lisfranc tarsometatarsal injuries. J Orthop Trauma 1996;10(2):119-122. https://doi.org/10.1097/00005131-199602000-00008

Stein RE: Radiological aspects of the tarsometatarsal joints. Foot Ankle 1983; 3(5): 286-9. https://doi.org/10.1177/107110078300300508

Mulier T, de Haan J,Vriesendorp P, Reynders P. The Treatment of Lisfranc Injuries: Review of Current Literature. Eur J Trauma Emerg Surg 2010; 36: 206–16 https://doi.org/10.1007/s00068-010-1034-5

Nunley JA, Vertullo CJ. Classification, investigation,and management of midfoot sprains: Lisfranc in-juries in the athlete. Am J Sports Med 2002;30(6):871–8. https://doi.org/10.1177/03635465020300061901

Curtis MJ, Myerson M, Szura B. Tarsometa-tarsal joint injuries in the athlete. Am J Sports Med. 1993; 21(4):497-502. https://doi.org/10.1177/036354659302100403

Hawkes NC, Flemming DJ, Ho VB. Subtle Lisfranc injury: low energy midfoot sprain. Mil Med. 2007; 172(9): 12–3. http://rad.usuhs.mil/amsus.html.

Quénu K, Küss G. Etude sur les luxations du métatarse: du diastases entre le 1st et le 2nd métatarsien. Rev Chir. 1909; 39: 1-72.

Hardcastle PH, Reschauer R, Kutscha-Lissberg E, Schoffmann W. Injuries to the tarso-metatarsal joint: incidence, classification and treatment. J Bone Joint Surg Br. 1982; 64(3): 349-56. https://www.ncbi.nlm.nih.gov/pubmed/7096403

Myerson MS, Fisher RT, Burgess AR, et al. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle 1986; 6(5): 225–42. https://doi.org/10.1177/107110078600600504

Sivakumar BS, An VVG, Oitment C, Myerson M . Subtle Lisfranc injuries: A topical review and modification of the classification system. Orthopedics 2018; 41(2): e168–e175. https://doi.org/10.3928/01477447-20180213-07

Watson TS, Shurnas PS, Denker J. Treatment of Lisfranc Joint Injury: Current Concepts. J Am Acad Orthop Surg 2010; 18: 718-728. https://doi.org/10.5435/00124635-201012000-00002

Moracia-Ochagavía I, Rodríguez-Merchán, EC. Lisfranc fracture-dislocations: current management. EFORT Open Rev 2019; 4: 430-44. https://doi.org/10.1302/2058-5241.4.180076

Stavlas P, Roberts CS, Xypnitos FN, et al. The role of reduction and internal fixation of Lisfranc fracture-dislocations: a systematic review of the literature. Int Orthop 2010; 34(8): 1083–91. https://doi.org/10.1007/s00264-010-1101-x

Alberta FG, Aronow MS, Barrero M, et al. Ligamen-tous Lisfranc joint injuries: a biomechanical compar-ison of dorsal plate and transarticular screw fixation.Foot Ankle Int 2005; 26(6): 462–73. https://doi.org/10.1177/107110070502600607

Sheibani-Rad S, Coetzee JC, Giveans MR, et al. Arthrodesis versus ORIF for Lisfranc fractures. Orthopedics 2012; 35(6): e868–73. https://doi.org/10.3928/01477447-20120525-26

Rammelt S, Schneiders W, Schikore H, Holch M, Heineck J, Zwipp H. Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation. J Bone Joint Surg Br 2008; 90-B: 1499–506. https://doi.org/10.1302/0301-620X.90B11.20695

Marcel Faraco Sobrado, Guilherme Honda Saito, Marcos Hideyo Sakaki. Epidemiological study on Lisfranc Injuries. Acta Ortop Bras. 2017;25(1):44-7 http://dx.doi.org/10.1590/1413-785220172501168995

Wei Rein, Hai-Bo Li, Ji-Ke Lu et al. Undisplaced subtle ligamentous Lisfranc injuries, conservative or surgical treatment with percutaneous position screws? Chinese Journal of Traumatology 2019;22: 196-201 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667927/

Miswan MF, Singh VA, Yasin NF. Outcome of surgically treated Lisfranc injury: a review of 34 cases. Ulus Travma Acil Cerrahi Derg. 2011;17(6):504-8. https://doi.org/10.5505/tjtes.2011.04809

Herscovici D Jr1, Scaduto JM2. Acute management of high-energy lisfranc injuries: A simple approach.

Injury. 2018 Feb;49(2):420-424. https://doi.org/10.1016/j.injury.2017.11.012

Tarkin S, Sop A, Pape HC. High-Energy Foot and Ankle Trauma: Principles for Formulating an Individualized Care Plan. Foot Ankle Clin Am 2008;13: 705-23 https://doi.org/10.1016/j.fcl.2008.08.002

Strauss EJ, Petrucelli G, Bong M et al. Blisters Associated With Lower-Extremity Fracture: Results of a Prospective Treatment Protocol. J Orthop Trauma 2006; 20: 618-22. https://doi.org/10.1097/01.bot.0000249420.30736.91

Haidukewych GJ. Temporary external fixation for the management of complex intra-and periarticular fractures of the lower extremity. J Orthop Trauma 2002;16 : 678-85. https://doi.org/10.1097/00005131-200210000-00012

Kandow TR, Siska PA, Evans AR et al. Staged treatment of high energy midfoot fracture dislocations. Foot Ankle Int 2014; 35: 1287-91. https://doi.org/10.1177/1071100714552077

Mulcahy H. Lisfranc Injury. Current concepts. Radiol Clin N Am 2018; 56 (6): 859-876. https://doi.org/10.1016/j.rcl.2018.06.003

Buda M, Kink S, Stavenuiter R. Reoperation Rate Differences Between Open Reduction Internal Fixation and Primary Arthrodesis of Lisfranc Injuries. Foot & Ankle International® 2018; 39(9): 1089 –1096. https://doi.org/10.1177/1071100718774005.

Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study. J Bone Joint Surg Am. 2006;88(3):514-520. https://doi.org/10.2106/JBJS.E.00228

Cochran G, Renninger C, Tompane T, et al. Primary arthrodesis versus open reduction and internal fixation for low-energy Lisfranc injuries in a young athletic population. Foot Ankle Int. 2017;38(9):957-963. https://doi.org/10.1177/1071100717711483.

VanPelt MD, Athey A, Yao J. et al. Is routune hardware removal following open reduction internal fixation of tarsometatarsal joint fracture/dislocation necessary? The Journal of Foot & Ankle Surgery 2019;58:226-230. https://doi.org/10.1053/j.jfas.2018.08.016

Yammine K, Boulos K. Assi C. Internal fixation or primary arthrodesis for Lisfranc complex joint injuries? A meta analysis of comparative studies. Eur J Trauma Emerg Surg 2019. https://doi.org/10.1007/s00068-019-01236-9

Coetzee JC1, Ly TV. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. Surgical technique. J Bone Joint Surg Am. 2007;89: 122-7. https://doi.org/10.2106/JBJS.F.01004

Publicado
2020-07-31
Sección
Articulos Originales