Cooling of the injured area was suggested to two patients therefore and 6 others had plaster splints applied. The time that had passed from the trauma to operative treatment ranged from 6 months to 20 years (mean 6 years). Medical attention was sought due to pain in 6 cases and deformities with pain in the remaining four. A control group included 10 people (8 men and 2 women) who had been properly diagnosed and subjected to adequate operative treatment directly after the trauma. Four persons with A type injuries and 6 with B type damage of an identical pathomorphism as in the study group were chosen for comparative analysis. All operative interventions in patients from the study group commenced with an attempt at an open reduction of the dislocations.
This, however, always ended with the resection of the damaged parts of the Lisfranc joint and its arthrodesis. In two cases, the displacement of the tarso-metatarsal junctions of two rays was accepted and arthrodesis was performed in the fixed subluxation. The patients of the control group were treated on the day of the trauma or, at most, after a few days’ postponement. The procedure began with an attempt at a closed reduction of the luxations or fractures. After putting it in the correct position, the Lisfranc joint was stabilized percutaneously with Kirschner wires. In six cases, the non-operative attempts were not successful, and the dislocations were reduced openly and stabilized with Kirschner wires. All patients underwent follow-up evaluation with physical examination in the outpatient department.
The functional status of the feet was assessed using the AOFAS scale for the midfoot. (Table 1) This scale takes into account the intensity of pain, activity limitations, footwear requirements, walking distance depending on the quality of the walking surface, and the foot axis. The scores on this scale range from 0 to 100 points. A self-designed function evaluation system (called the Lublin Foot Functional Score) was also developed, which included the assessment of tiptoeing, running, climbing up and down the stairs, weight-bearing of the foot in supination, presence of skin changes (e.g. corns), occurrence of swelling, as well as other patient complaints. (Table 2) Control radiographs were performed in standard projections in all of the examined patients from both groups.
The mean follow-up was 13 years in the study group and 8 years in the control group. Table 1 AOFAS Mid-foot Scale. Table Anacetrapib 2 Lublin foot functional score. RESULTS Statistical evaluation using the non-parametric Mann-Whitney U test and the non-parametric Wilcoxon test demonstrated significant statistical differences between the scores of the two groups on the AOFAS scale and the Lublin scale at p< 0.05. (Table 3) Table 3 Scores obtained by patients in the study and control groups on the AOFAS and Lublin scales were statistically significant at p<0.05.