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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
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
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
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.
Qual era a principal questão de investigação?
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)
De que é que me devo lembrar mais?
The primary arthrodesis intervention resulted in better short- and medium-term clinical and functional outcomes in the treatment of ligamentous Lisfranc joint injuries.
Como é que isto afectará o tratamento dos meus doentes?
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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