The FIRM Trial - A Randomized Clinical Trial Evaluating Fixation In-situ vs Removal for Midfoot Lisfranc Injuries
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 100
- 试验地点
- 2
- 主要终点
- Foot and Ankle Ability Measure (FAAM)
研究概览
简要总结
Injuries to the midfoot tarsometatarsal joint, or Lisfranc joint, are notoriously debilitating. Poor functional outcomes following Lisfranc injuries have motivated surgeons to look for potential improvements in post-operative care. There are currently no evidence-based guidelines to direct implant removal for patients with operatively treated Lisfranc injuries. Routine implant removal has significant implications related to health care costs, lost time from work, potential surgical complications, and possibly functional impairment. Therefore, stakeholders including patients, surgeons, employers, and administrators will benefit from evidence-based guidelines for implant removal following operatively treated Lisfranc injuries. To date, there has not been a prospective randomized study evaluating the efficacy of implant removal compared with implant retention for Lisfranc injuries. The aim of this study is to directly compare patient-reported and radiographic outcomes, in order to provide robust evidence for optimal post-operative treatment regimens regarding implant removal or retention for operatively treated Lisfranc injuries.
详细描述
This study is a multicenter, randomized clinical trial comparing implant retention (Retention Group) to scheduled implant removal (Removal Group) in 100 skeletally mature patients with Lisfranc injuries previously treated with screw and/or plate fixation. The primary outcome measure is the validated, patient-reported Foot and Ankle Ability Measure (FAAM) at 1-year post initial Lisfranc injury. Secondary outcome measures include: 1. American Orthopedics Foot and Ankle Midfoot Score (AOFAS), 2. patient-reported Visual Analogue Scale (VAS) for Foot and Ankle, 3. range of motion, 4. radiographic assessment of Lisfranc reduction, 5. comparative cost analysis between treatment groups. This study will follow patients for 1-year post-injury.
Patients, surgeons, employers, and administrators will benefit from an evidence-based approach to implant removal following operatively treated Lisfranc injuries. This study will allow orthopaedic surgeons to counsel patients regarding the advantages and disadvantages of implant retention compared with removal. This study will provide robust data to inform clinical decision making for surgeons and provide patients with information regarding expected functional outcomes following Lisfranc injuries.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •18 years of age or older and skeletally mature
- •Subject has Lisfranc injury that was previously treated with screws and/or plate fixation within 21 days of initial injury
- •Subject must be enrolled in study within 6 weeks (+/-2 weeks) from time of initial fixation operation
- •The patient must be medically fit for anaesthesia
- •Subject is willing and able to provide written informed consent for trial participation
- •Subject is willing and able to comply with the study protocol including return for all follow-up evaluations
排除标准
- •Subject has a significant pre-existing foot injury or deformity
- •There has been loss of fixation or reduction prior to enrollment
- •Subject was treated with a primary tarsometatarsal joint fusion
- •Subject has a delay in initial treatment greater than 21 days from time of injury
- •Subject has an active infection in the area of surgical approach
- •Subject has concomitant injury which, in the opinion of the attending surgeon, is likely to impair rehabilitation or prolong fracture healing time
- •Subject has a history of rheumatoid arthritis, Diabetes, metabolic bone disease (including osteoporosis actively being treated), active malignancy, pathologic fracture or other pre-existing pathologic condition affecting the Lisfranc complex
- •Subject has a high risk of death from surgery (ASA physical status Class V)
- •Subject is likely unable to maintain follow-up
- •Subject has cognitive impairment or language difficulties that would impede the valid completion of questionnaires
- •Subject is pregnant or planning on becoming pregnant in the following year
结局指标
主要结局
Foot and Ankle Ability Measure (FAAM)
时间窗: 24 months
FAAM is a patient-reported outcome tool used to assess physical function at 24 months post initial Lisfranc surgery. This instrument includes 2 sub-scales: activities of daily living sub scale of 21 items and sport sub scale of 8 items. Answers for both scales are based on a Likert scale (4-0) of: 4) No difficulty, 3) Slight difficulty, 2) Moderate difficulty, 1) Extreme difficulty, and 0) Unable to do. Questions for which "N/A" is indicated are not counted. Two scores are reported, one for each sub scale. To calculate the score for either sub scale, the total number of points are added, divided by the number of possible points (84 for ADL and 32 for sports), and multiplied by 100. Higher scores reflect a higher level of physical function.
次要结局
- American Orthopedics Foot and Ankle Midfoot Score (AOFAS)(24 months)
- Patient-reported Visual Analogue Scale (VAS) for Foot and Ankle(24 months)
- Radiographic assessment of Lisfranc reduction(24 months)
- Range of motion (ROM)(24 months)
- Comparative cost analysis between treatment groups(24 months)
研究者
Prism Schneider
Orthopaedic Trauma Research Lead
University of Calgary