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Baboeram NSVL, Sanders FRK, Wellenberg RHH, Dobbe JGG, Streekstra GJ, Maas M, Schepers T. Primary arthrodesis versus open reduction and internal fixation following intra-articular calcaneal fractures: a weight-bearing CT analysis. Arch Orthop Trauma Surg 2024; 144:755-762. [PMID: 38129717 DOI: 10.1007/s00402-023-05120-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/29/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To compare primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in displaced intra-articular calcaneal fractures (DIACFs), based on clinical outcome and 2D and 3D geometrical analyses obtained from weight-bearing (WB) cone-beam CT images. MATERIALS AND METHODS In this prospective study, 40 patients with surgically treated calcaneal fractures were included, consisting of 20 PA and 20 ORIF patients. Weight-bearing cone-beam CT-images of the left and right hindfoot and forefoot were acquired on a Planmed Verity cone-beam CT-scanner after a minimum of 1-year follow-up. Automated 2D and 3D geometric analyses, i.e., (minimal and average) talo-navicular joint space, calcaneal pitch (CP), and Meary's angle (MA), were obtained for injured and healthy feet. Clinical outcomes were measured using the EQ5D and FFI questionnaires. RESULTS Overall, there were no differences in baseline patient characteristics apart from age (p < 0.005). The calcaneal pitch in 2D after treatment by ORIF (13.8° ± 5.6) was closer to the uninjured side (18.1° ± 5.5) compared to PA (10.9° ± 4.5) (p < 0.001). Meary's angle in 2D was closer to the uninjured side (8.7° ± 6.3) after surgery in the PA cohort (7.0° ± 5.8) compared to the ORIF cohort (15.5° ± 5.9) (p = 0.046). In 3D measurements, CP was significantly decreased for both cohorts after surgery (- 4.09° ± 6.2) (p = 0.001). MA was not significantly affected overall or between cohorts in 3D. Clinical outcomes were not significantly different between the ORIF and PA cohorts. None of the radiographic measurements in 2D or 3D correlated with any of the clinical outcomes studied. CONCLUSION Three-dimensional WB CT imaging enables functional 2D and 3D analyses under natural load in patients with complex calcaneal fractures. Based on clinical outcome, both PA and ORIF appear viable treatment options. Clinical correlation with geometrical outcomes remains to be established.
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Affiliation(s)
- N S V L Baboeram
- Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
| | - F R K Sanders
- Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - R H H Wellenberg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - M Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - T Schepers
- Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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van den Boom NAC, Douwes I, Poeze M, Evers SMAA. Patient experiences and preferences during treatment and recovery of Lisfranc fractures: A qualitative interview study. Injury 2022; 53:4152-4158. [PMID: 36273922 DOI: 10.1016/j.injury.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/25/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
AIM To determine from a patient perspective what improves the quality of care and patient satisfaction during the treatment and recovery process of Lisfranc fractures and to reveal possible points for improvement in this process. METHODS We performed a qualitative study based on semi-structured interviews with patients treated for a Lisfranc fracture-dislocation in the Netherlands with either open reduction and internal fixation or primary arthrodesis, until data saturation was reached, focusing on the quality of care during treatment and recovery, from a patient perspective. RESULTS Data saturation was reached after interviewing 10 patients. The main themes emerging from the analysis were expectation management regarding the recovery period; communication with and between health care providers; information provided during consultations; and support during the recovery period. Participants expressed a need for improved provision of information about the different treatment options, the different kinds of pain that can arise, the expected duration of the recovery period, education on strong pain killers, likelihood of a second surgery, risks of osteoarthritis, risks of the surgery itself, allied health care and patient experiences. Participants mentioned the importance of good allied health care and a preference for starting allied health care as soon as possible. Insoles and compression socks were also appreciated by various participants. Finally, multiple patients saw a positive attitude on the part of the health care providers towards the recovery period as a key factor in recovery. CONCLUSION This study found that patients value more tailored approaches to the pre-and post-operative care program, more guidance regarding allied health care (physiotherapy), and a broader scope of available references and information for patients, both oral (during consultations and in informative videos) and written, such as brochures or evidence-based web pages and mobile platforms, which may be offered during consultations or when being discharged from the hospital.
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Affiliation(s)
- N A C van den Boom
- Maastricht University Medical Centre, Dept. of Trauma Surgery. P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Maastricht University, Care and Public Health Research Institute (CAPHRI). Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University. Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML). Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
| | - I Douwes
- Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML). Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - M Poeze
- Maastricht University Medical Centre, Dept. of Trauma Surgery. P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University. Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML). Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - S M A A Evers
- Maastricht University, Care and Public Health Research Institute (CAPHRI). Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Maastricht University, Faculty of Health, Medicine and Life Sciences (FHML). Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands; Maastricht University, Dept of Health Services Research. Duboisdomein 30, 6229 GT Maastricht, The Netherlands
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Sun C, Miao X, Zhang M, Yang Y, Zhao H, Tang X, Yu G. Lisfranc injuries with dislocation the first tarsometatarsal joint: primary arthrodesis or internal fixation (a randomized controlled trial). Int Orthop 2022; 46:2529-2537. [PMID: 35723701 DOI: 10.1007/s00264-022-05478-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Open reduction and internal fixation (ORIF) is a popular method for treatment of displaced Lisfranc injuries. However, even with anatomic reduction and solid internal fixation, treatment does not provide good outcomes in certain severe dislocations. The purpose of this study was to compare ORIF and primary arthrodesis (PA) of the first tarsometatarsal (TMT) joint for Lisfranc injuries with the first TMT joint dislocation. METHODS Seventy-eight Lisfranc injuries with first TMT joint dislocation were finally enrolled and analyzed in a prospective, randomized trial comparing ORIF and PA. They were 50 males and females with a mean age of 40.7 years and randomized to ORIF group and PA group. Outcome measures included radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale, Foot and Ankle Ability Measure (FAAM) Sports subscale, visual analog scale (VAS), and the 36-Item Short Form Health Survey (SF-36). Complications and revision rate were also analyzed. RESULTS Forty patients were treated by ORIF, while PA group includes 38 cases. Patients were followed up for 37.8(range, 24-48) months. At final follow-up, the mean AOFAS midfoot score (P < 0.01), the FAAM Sports subscale (P < 0.01), the physical function score (P < 0.05), and the Bodily Pain score of SF-36 (P < 0.05) after ORIF treatment were significantly lower than PA group. The mean VAS score in ORIF group was higher (P < 0.01). In ORIF group, redislocation of the first TMT joint was observed in ten cases, and thirteen patients had pain in midfoot. No redislocation and no hardware failure were identified in PA group. CONCLUSION PA of the first TMT joint provided a better medium-term outcome than ORIF for Lisfranc injuries with the first TMT dislocation. Possible complications and revision could be avoided by PA for dislocated first ray injuries.
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Affiliation(s)
- Chengyi Sun
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No.1, Dong Jiao Min Lane, Dong Cheng District, Beijing, 100730, China
| | - Xudong Miao
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Mingzhu Zhang
- Center of Foot and Ankle Surgery, Beijing Tongren Hospital, Capital Medical University, No.1, Dong Jiao Min Lane, Dong Cheng District, Beijing, 100730, China.
| | - Yunfeng Yang
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Hongmou Zhao
- Foot and Ankle Surgery Department, Honghui Hospital of Xi'an Jiaotong University, Xi'an, 710054, China
| | - Xin Tang
- Department of Orthopedic Trauma, The First Affiliated Hospital of Dalian Medical University, Dalian, 201318, China
| | - Guangrong Yu
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
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van den Boom NAC, Stollenwerck GANL, Lodewijks L, Bransen J, Evers SMAA, Poeze M. Lisfranc injuries: fix or fuse? : a systematic review and meta-analysis of current literature presenting outcome after surgical treatment for Lisfranc injuries. Bone Jt Open 2021; 2:842-849. [PMID: 34643414 PMCID: PMC8558450 DOI: 10.1302/2633-1462.210.bjo-2021-0127.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS This systematic review and meta-analysis was conducted to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA) in the treatment of Lisfranc injuries, regarding patient-reported outcome measures (PROMs), and risk of secondary surgery. The aim was to conclusively determine the best available treatment based on the most complete and recent evidence available. METHODS A systematic search was conducted in PubMed, Cochrane Controlled Register of Trials (CENTRAL), EMBASE, CINAHL, PEDro, and SPORTDiscus. Additionally, ongoing trial registers and reference lists of included articles were screened. Risk of bias (RoB) and level of evidence were assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The random and fixed-effect models were used for the statistical analysis. RESULTS A total of 20 studies were selected for this review, of which 12 were comparative studies fit for meta-analysis, including three randomized controlled trials (RCTs). This resulted in a total analyzed population of 392 patients treated with ORIF and 249 patients treated with PA. The mean differences between the two groups in American Orthopedic Foot and Ankle Society (AOFAS), VAS, and SF-36 scores were -7.41 (95% confidence interval (CI) -13.31 to -1.51), 0.77 (95% CI -0.85 to 2.39), and -1.20 (95% CI -3.86 to 1.46), respectively. CONCLUSION This is the first study to find a statistically significant difference in PROMs, as measured by the AOFAS score, in favour of PA for the treatment of Lisfranc injuries. However, this difference may not be clinically relevant, and therefore drawing a definitive conclusion requires confirmation by a large prospective high-quality RCT. Such a study should also assess cost-effectiveness, as cost considerations might be decisive in decision-making. Level of Evidence: I Cite this article: Bone Jt Open 2021;2(10):842-849.
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Affiliation(s)
- Noortje Anna Clasina van den Boom
- Department of Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- Nutrim School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | | | - Laureanne Lodewijks
- Department of Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jeroen Bransen
- Department of Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Silvia M A A Evers
- Nutrim School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Maastricht, the Netherlands
| | - Martijn Poeze
- Department of Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- Nutrim School of Nutrition & Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
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Abstract
The quest for the best treatment of displaced intraarticular calcaneal fractures continues. The open reduction and internal fixation of displaced intraarticular calcaneal fractures yields the best results if anatomic reduction is obtained and complications are avoided. The sinus tarsi approach is becoming the new gold standard. In cases with severe comminution or when anatomic reduction cannot be obtained, a primary subtalar arthrodesis is a valuable option, if the overall anatomy of the calcaneus is corrected first. This review discusses the open reduction and internal fixation of displaced intraarticular calcaneal fractures and the indications and technique of the primary arthrodesis.
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Affiliation(s)
- Tim Schepers
- Trauma Unit, Amsterdam UMC Location AMC, Room G5-250, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Abstract
Calcaneal fractures account for up to 75% of all foot fractures and 1% to 2% of all fractures. Approximately 75% of calcaneal fractures are intraarticular, resulting in a prolonged recovery, more pain, and disability. The most common mechanism of injury includes falls from a height and motor vehicle accidents. This article reviews studies that compare nonoperative with operative treatment. The literature continues to support surgical intervention; however, these injuries can still be managed nonoperatively in certain clinical scenarios. This article focuses on the surgical management of intraarticular calcaneal fractures and highlights the sinus tarsi approach.
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Affiliation(s)
- Spencer J Monaco
- Premier Orthopaedics, 400 McFarlan Road, Suite 100, Kennett Square, PA 19348, USA
| | - Michael Calderone
- Premier Orthopaedics, 400 McFarlan Road, Suite 100, Kennett Square, PA 19348, USA
| | - Justin J Fleming
- University Orthopaedic Associates, 2 World's Fair Drive, Somerset, NJ 08873, USA.
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Dingemans SA, Meijer ST, Backes M, de Jong VM, Luitse JSK, Schepers T. Outcome following osteosynthesis or primary arthrodesis of calcaneal fractures: A cross-sectional cohort study. Injury 2017; 48:2336-2341. [PMID: 28843716 DOI: 10.1016/j.injury.2017.08.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/02/2017] [Accepted: 08/13/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Calcaneal fractures are uncommon and have a substantial impact on hindfoot function and quality of life. Several surgical treatment options are available; both in surgical approach and type of operation. The aim of this study was to compare functional outcome and quality of life following ORIF and primary arthrodesis. Furthermore, predictors of worse functional outcome were explored. METHODS A retrospective cross-sectional cohort study was performed in patients with surgical fixation of a calcaneal fracture with a minimum follow-up of 18 months. Patients received ORIF through the 1) Extended Lateral Approach (ELA), 2) Sinus Tarsi Approach (STA) or 3) primary arthrodesis via STA. Participants were presented a questionnaire containing demographics, the AOFAS hindfoot scale, Foot Function Index, SF-36, EQ-5D and patient satisfaction. RESULTS In total 95 patients participated in this study. The three groups were comparable regarding patient characteristics. A median score of 74.5 points on the AOFAS hindfoot scale and 11.9 on the FFI was found for the entire group. There were no statistically significant differences between patients with ORIF of primary arthrodesis. Patients scored a median of 49.0 on the Physical Component Scale of the SF-36 and 55.4 on the Mental Component Scale. On the EQ-5D patients scored a median of 0.8 points. Again no statistically significant differences were observed between the three subgroups. Socio-economic status was the only statistically significant predictor of worse functional outcome (β: 4.06, 95% CI: 0.50-7.62) after multivariable analysis. INTERPRETATION Good midterm outcomes following in terms of functional outcome and in quality of life are observed. We observed no statistical significant difference in functional outcome between patients with ORIF and patients with primary arthrodesis. The only predictor of worse functional outcome is a lower socio-economic status.
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Affiliation(s)
- Siem A Dingemans
- Trauma Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - Sjoerd T Meijer
- Trauma Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - Manouk Backes
- Trauma Unit, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Jan S K Luitse
- Trauma Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Unit, Academic Medical Center, Amsterdam, The Netherlands.
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