Improved outcomes with primary arthrodesis in treating ligamentous Lisfranc joint injuries .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(12):107 J Bone Joint Surg Am. 2006 Mar;88(3):514-2041 patients with isolated acute or subacute primary ligamentous Lisfranc injuries were randomised to undergo either a primary open reduction and internal fixation procedure or a primary partial arthrodesis procedure. Short- and long-term functional and clinical outcomes were examined. The results indicated that the primary arthrodesis intervention produced better short- and medium-term outcomes compared to the open reduction and internal fixation procedure.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
3/4
Randomization
2/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Lisfranc joint injuries are tarsometatarsal dislocations or fracture-dislocations of the foot. This injury is not common and are often misdiagnosed or missed. The accepted method of treatment for this injury is an open reduction and internal fixation procedure. However, the optimal method of treatment is debated. This study compares the open reduction and internal fixation treatment with primary partial arthrodesis in treating high-energy ligamentous Lisfranc injuries.
¿Cuál era la pregunta principal de la investigación?
What are the short- and long-term clinical and functional outcomes of treating patients with primary ligamentous Lisfranc injuries with primary open reduction and internal fixation compared to primary partial arthrodesis?
- 18/20 patients from the open-reduction group obtained an anatomic initial reduction compared to 20/21 patients from the arthrodesis group.
- The open-reduction group reported a mean AOFAS Midfoot score of 68.6 points compared to 88 points from the arthrodesis group at the two-year follow-up. (p=0.005)
- Persistent pain was reported by 5 patients from the open-reduction group due to osteoarthrosis or the development of deformity. These patients were treated with arthrodesis.
- The estimated postoperative level of activities reported by the patients from the primary arthrodesis group was 92% of their preinjury, preoperative level, compared to an estimation of 65% from the open-reduction group. (p<0.005)
¿Qué es lo que más debo recordar?
The primary arthrodesis intervention resulted in better short- and medium-term clinical and functional outcomes in the treatment of ligamentous Lisfranc joint injuries.
¿Cómo afectará esto al cuidado de mis pacientes?
The results from this study indicate that patients with ligamentous Lisfranc joint injuries may find improved clinical and radiographic outcomes when undergoing a primary partial arthrodesis intervention compared to the more traditional open reduction and internal fixation procedure.
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