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Ghandour S, Bhimani R, Yahya A, Eltouny E, Guss D, Waryasz G, Vicentini JRT, Ashkani-Esfahani S, Stewart ZE. The utility of point-of-care dynamic ultrasonography for the diagnosis of subtle isolated ligamentous Lisfranc injuries: a cadaveric study. Skeletal Radiol 2024:10.1007/s00256-024-04771-8. [PMID: 39138660 DOI: 10.1007/s00256-024-04771-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVES To assess if Lisfranc injury can be detected by US with and without abduction stress. METHODS Eight cadaveric feet were obtained. The following measurements were obtained in the uninjured feet: C1M2 and C1C2 intervals and TMT1 and TMT2 dorsal step-off distances. Measurements were obtained both with and without abduction stress using ultrasound. The injury model was created by transecting the Lisfranc ligament complex, after which the observers performed the measurements again. Statistical analysis was used to identify differences between intact and injured models, to determine diagnostic cut-off values for identifying Lisfranc injuries, and to assess interobserver/intraobserver reliability. RESULTS There was a significant difference in the mean C1M2 interval, both with and without abduction stress, between the intact and torn Lisfranc ligament (p < 0.001). A C1M2 interval with stress of > 2.03 mm yielded 81% sensitivity and 72% specificity for Lisfranc disruption. There was no significant difference in the mean C1C2 interval of the torn versus intact Lisfranc ligament without stress (p = 0.10); however, the distance was significantly different with the application of stress (p < 0.001). The C1C2 interval of > 1.78 mm yielded 72% sensitivity and 69% specificity for Lisfranc injury under stress. There were no significant differences in the mean TMT1 or TMT2 dorsal step-off measurements between the intact and torn Lisfranc ligaments. All observers showed good intraobserver ICCs. The interobserver ICCs for all measurements were good or excellent, except for TMT1, which was moderate. CONCLUSION Ultrasonography is a promising point-of-care imaging tool to detect Lisfranc ligamentous injuries when measuring C1M2 and C1C2 distances under abduction stress.
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Affiliation(s)
- Samir Ghandour
- Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Massachusetts General Hospital, Boston, USA.
- The Foot and Ankle Research and Innovation Laboratory, Harvard Medical School, Boston, USA.
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Boston, USA.
| | - Rohan Bhimani
- Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Massachusetts General Hospital, Boston, USA
- The Foot and Ankle Research and Innovation Laboratory, Harvard Medical School, Boston, USA
| | - Ayesha Yahya
- Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Massachusetts General Hospital, Boston, USA
- The Foot and Ankle Research and Innovation Laboratory, Harvard Medical School, Boston, USA
| | - Ehab Eltouny
- Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Massachusetts General Hospital, Boston, USA
| | - Daniel Guss
- Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Massachusetts General Hospital, Boston, USA
- The Foot and Ankle Research and Innovation Laboratory, Harvard Medical School, Boston, USA
| | - Gregory Waryasz
- Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Massachusetts General Hospital, Boston, USA
- The Foot and Ankle Research and Innovation Laboratory, Harvard Medical School, Boston, USA
| | - J Rafael T Vicentini
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Boston, USA
| | - Soheil Ashkani-Esfahani
- Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Massachusetts General Hospital, Boston, USA
- The Foot and Ankle Research and Innovation Laboratory, Harvard Medical School, Boston, USA
| | - Zachary E Stewart
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Boston, USA
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Dombrowsky AR, Strickland CD, Walsh DF, Hietpas K, Conti MS, Irwin TA, Cohen BE, Ellington JK, Jones CP, Shawen SB, Ford SE. Nitinol Staple Use in Primary Arthrodesis of Lisfranc Fracture-Dislocations. Foot Ankle Int 2024; 45:690-697. [PMID: 38850062 DOI: 10.1177/10711007241227880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Primary arthrodesis of Lisfranc fracture-dislocations is a reliable treatment option, yet concerns remain about nonunion. Nitinol staple use has recently proliferated in midfoot arthrodesis. The purpose of this study is to examine the union rate of primary arthrodesis of acute Lisfranc fracture-dislocations treated with nitinol staples compared with traditional plate-and-screw fixation. The secondary objective is to assess the difference in operative times and reoperation rates. METHODS Midfoot fracture-dislocations treated with primary arthrodesis by 7 foot and ankle orthopaedic surgeons were reviewed. Of 160 eligible patients, 121 patients (305 joints) met the required 4-month minimum radiographic follow-up. Radiographic outcomes were analyzed at the individual joint level. Each joint was classified as either staples alone (45 patients, 154 joints), staples plus plates and screws (hybrid) (45 patients, 40 joints), or plates and screws alone (31 patients, 111 joints). The primary outcome was arthrodesis union at each joint fused. RESULTS Nonunion was more common (9.0%, 10/111) among joints fixed with plate and screws than with hybrid (2.5%, 1/40) or staples only (1.3%, 2/154) (P = .0085). Multivariable regression demonstrated that autograft use was independent associated with union (P = .0035) and plate-and-screw only fixation was an independent risk factor for nonunion (P = .0407). Median operating room and tourniquet times were shorter for hybrid (92 and 83 minutes) and staple only (67 and 63 minutes) constructs compared to plate-and-screw only fixation (105 and 95 minutes) (P ≤ .0001 and .0003). There was no difference in reoperation rates among patients with different fixation types. CONCLUSION We found that use of nitinol compression staple and bone autograft in primary arthrodesis of Lisfranc and midfoot fracture-dislocations was associated with both improved union rates and shorter tourniquet and operative times compared to traditional plate-and-screw fixation techniques. LEVEL OF EVIDENCE Level III, therapeutic.
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Affiliation(s)
| | | | - Devin F Walsh
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
| | - Kayla Hietpas
- OrthoCarolina Research Institute, Charlotte, NC, USA
| | | | - Todd A Irwin
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
| | - Bruce E Cohen
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
| | - J Kent Ellington
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
| | - Carroll P Jones
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
| | - Scott B Shawen
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
| | - Samuel E Ford
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
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Ochuba A, Murdock CJ, Xu AL, Snow M, Schmerler J, Leland CR, McDaniel C, Thompson J, Aiyer AA. Open Reduction Internal Fixation vs Primary Arthrodesis for Lisfranc Fracture-Dislocations: A Cost Analysis. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114231224727. [PMID: 38298264 PMCID: PMC10829492 DOI: 10.1177/24730114231224727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Background Lisfranc fracture-dislocation is an uncommon but serious injury that currently lacks universal consensus on optimal operative treatment. Two common fixation methods are open reduction and internal fixation (ORIF) and primary arthrodesis (PA). The objective of this study is to analyze the cost difference between ORIF and PA of Lisfranc injuries, along with the contribution of medical services to overall costs. Methods This was a retrospective cost analysis of the MarketScan database from 2010 to 2020. MarketScan is an insurance and commercial claims database that integrates deidentified patient information. It captures person-specific clinical utilization, expenditures, and enrollment across inpatient and outpatient services. Patients undergoing primary ORIF (CPT code 28615) vs PA (28730 and 28740) for Lisfranc fracture-dislocation were identified. The primary independent variable was ORIF vs PA of Lisfranc injury. Total costs due to operative management was the primary objective. The utilization of and costs contributed by medical services was a secondary outcome. Results From 2010 to 2020, a total of 7268 patients underwent operative management of Lisfranc injuries, with 5689 (78.3%) ORIF and 1579 (21.7%) PA. PA was independently associated with increased net and total payment and coinsurance, clinic visits, and imaging, and patients attended significantly more PT sessions. Conclusion Using this large database that does not characterize severity or extent of injury, we found that treatment of Lisfranc fracture-dislocation with ORIF was associated with substantially lower initial episode of treatment costs compared with PA. Specific excessive cost drivers for PA were clinic visits, PT sessions, and imaging. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Arinze Ochuba
- Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Amy L. Xu
- Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Morgan Snow
- Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Christopher R. Leland
- Massachusetts General Hospital/Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Claire McDaniel
- Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - John Thompson
- Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Herbosa CG, Esper GW, Nwakoby EV, Leucht P, Konda SR, Tejwani NC, Egol KA. Screws Alone for Acute Lisfranc Injuries Fixed Without Arthrodesis: A Better "Value" Than Plating in the Short Term. J Foot Ankle Surg 2023; 62:768-773. [PMID: 36966966 DOI: 10.1053/j.jfas.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/15/2023] [Accepted: 03/19/2023] [Indexed: 05/12/2023]
Abstract
This study compares outcomes of patients with Lisfranc injuries treated with screw only fixation constructs to those treated with dorsal plate and screw constructs. Seventy patients who underwent surgical treatment for acute Lisfranc injury without arthrodesis and minimum 6-month (mean >1-year) follow-up were identified. Demographics, surgical information, and radiographic imaging were reviewed. Cost data were compared. The primary outcome measure was the American Orthopedic Foot and Ankle Surgery (AOFAS) midfoot score. Univariate analysis through independent sample t tests, Mann-Whitney U, and chi-squared compared the populations. Twenty-three (33%) patients were treated with plate constructs and 47 (67%) with screw only fixation. The plate group was older (49 ± 18 vs 40 ± 16 years, p = .029). More screw constructs treated isolated medial column injuries compared to plate constructs (92% vs 65%, p = .006). At latest follow-up (mean 14 ± 13 months), all tarsometatarsal joints were aligned. There was no difference in AOFAS midfoot scores. Plate patients experienced longer operations (131 ± 70 vs 75 ± 31 minutes, p < .001) and tourniquet time (101 ± 41 vs 69 ± 25 minutes, p = .001). Plate constructs were more expensive than screw ($2.3X ± $2.3X vs $X ± $0.4X, p < .001) ($X is the mean cost of screws alone). Plate patients had a higher incidence of wound complications (13% vs 0%, p = .012). Treatment of Lisfranc fracture dislocation injuries with screws only demonstrated a higher value procedure as similar outcomes were found amidst lower implant costs. Screw only fixation required a shorter operative and tourniquet time with less frequent wound complications. Screw only fixations proved mechanically sound enough to achieve goals of repair without inferior outcomes.
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Affiliation(s)
- Christopher G Herbosa
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Garrett W Esper
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Ekenedilichukwu V Nwakoby
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Philipp Leucht
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Sanjit R Konda
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Nirmal C Tejwani
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY
| | - Kenneth A Egol
- Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.
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Carter TH, Heinz N, Duckworth AD, White TO, Amin AK. Management of Lisfranc Injuries: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202304000-00001. [PMID: 37014938 DOI: 10.2106/jbjs.rvw.22.00239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
» There is a spectrum of midtarsal injuries, ranging from mild midfoot sprains to complex Lisfranc fracture-dislocations. » Use of appropriate imaging can reduce patient morbidity, by reducing the number of missed diagnoses and, conversely, avoiding overtreatment. Weight-bearing radiographs are of great value when investigating the so-called subtle Lisfranc injury. » Regardless of the operative strategy, anatomical reduction and stable fixation is a prerequisite for a satisfactory outcome in the management of displaced injuries. » Fixation device removal is less frequently reported after primary arthrodesis compared with open reduction and internal fixation based on 6 published meta-analyses. However, the indications for further surgery are often unclear, and the evidence of the included studies is of typically low quality. Further high-quality prospective randomized trials with robust cost-effectiveness analyses are required in this area. » We have proposed an investigation and treatment algorithm based on the current literature and clinical experience of our trauma center.
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Affiliation(s)
- Thomas H Carter
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nicholas Heinz
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Timothy O White
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Anish K Amin
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Martin MP, Patel AH, Cole MW, Gadinsky NE, Collins L, Sherman WF. A Rare Case of a Lisfranc Ligament Transection. Orthop Rev (Pavia) 2023; 15:56664. [PMID: 36776274 PMCID: PMC9907328 DOI: 10.52965/001c.56664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Ligamentous Lisfranc injuries, which mimic a surgical transection are rare. Left untreated or missed, these injuries may result in severe complications including long-term disability. The present case describes a unique mechanism of injury via a sharp object puncture through the plantar surface of the midfoot. It highlights the utility of planning staged procedures to remove a large foreign body object, reports notable intraoperative techniques, and provides a decision management guide for treating this type of injury. Extensive surgical planning may be required when encountering similar cases and knowledge of this may be useful to providers.
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Affiliation(s)
| | | | | | | | - Lacee Collins
- Orthopaedic SurgeryTulane University School of Medicine
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7
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Shim DW, Choi E, Park YC, Shin SC, Lee JW, Sung SY. Comparing bilateral feet computed tomography scans can improve surgical decision making for subtle Lisfranc injury. Arch Orthop Trauma Surg 2022; 142:3705-3714. [PMID: 34599354 DOI: 10.1007/s00402-021-04182-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Subtle Lisfranc injuries (SLIs) are challenging to diagnose. Although weightbearing (WB) radiographs have been suggested to identify SLIs, approximately 20% are missed on initial radiographic assessment. Computed tomography (CT) has been suggested as an alternative, but has not provided any diagnostic guideline. Therefore we compared measurement techniques on radiographs and bilateral foot CT scans for the efficiency of diagnosis and making surgical decisions for SLI. METHODS We retrospectively investigated patients diagnosed with SLIs between January 2014 and January 2020. Distances between both medial cuneiform and second metatarsal base (C1M2), and the first and second metatarsal bases (M1M2), were measured on bilateral WB radiographs. Bilateral foot CT scans were taken, and the distances between C1M2 were checked on the axial and three points of the coronal plane (top, middle, and base). The surgical indication was > 1 mm of diastasis on CT scan. Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score at final follow-up. Intraobserver and interobserver agreements were assessed. RESULTS Thirty patients with SLIs were reviewed. Twenty-four patients underwent surgical fixation (Group A) and six patients were treated conservatively (Group B). The side-to-side difference (STSD) of C1M2 and M1M2 distances greater than 1 mm showed 91.7% and 54.2% sensitivity, and 66.7% and 16.7% specificity, respectively. Investigating STSDs of all points on CT scans were informative to discriminate both groups (P ≤ 0.038). Clinical outcomes showed no significant difference between the groups (P = 0.631). Intraclass and interclass correlation coefficient values showed good to very good reliability, except for STSD of WB M1M2 distance and the coronal top plane. CONCLUSION Investigating bilateral foot CT scans was significantly efficient and reliable for the diagnosis and treatment plan for SLI. On radiographs, STSD of WB C1M2 distance was more sensitive than STSD of WB M1M2 distance. LEVEL OF EVIDENCE Case control study; III.
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Affiliation(s)
- Dong Woo Shim
- Department of Orthopedic Surgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100beon-gil, Seo-gu, Incheon, 22711, South Korea
| | - Eunyoung Choi
- Student, Catholic Kwandong University College of Medicine, 7, Simgok-ro 100beon-gil, Seo-gu, Incheon, 22711, South Korea
| | - Young-Chang Park
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
| | - Sung Chul Shin
- Department of Orthopedic Surgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100beon-gil, Seo-gu, Incheon, 22711, South Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Seung-Yong Sung
- Department of Orthopedic Surgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100beon-gil, Seo-gu, Incheon, 22711, South Korea.
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8
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Choi JY, Yu OJ, Suh JS. Factors influencing postoperative residual diastasis after the operative treatment of acute Lisfranc fracture dislocation. Arch Orthop Trauma Surg 2022; 142:2685-2694. [PMID: 34244876 DOI: 10.1007/s00402-021-04058-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/03/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Clinically, surgeons may frequently encounter residual diastasis between the medial cuneiform and 2nd metatarsal base after the operative treatment of acute Lisfranc fracture dislocations. The purpose of this study was to identify factors influencing postoperative residual diastasis. We specifically focused on the preoperative fracture pattern using 3-dimensional computed tomography (3D-CT). MATERIALS AND METHODS Radiographic and clinical findings of 66 patients who underwent operative treatment for acute Lisfranc fracture dislocation were reviewed. Patients were grouped according to residual diastasis evaluated by weight-bearing anteroposterior radiograph of the foot at the final follow-up. Residual diastasis was defined as distance between the medial cuneiform and 2nd metatarsal base greater than the distance on the contralateral side by 2 mm or more. Demographic parameters and fracture patterns based on preoperative foot 3D-CT were compared. A paired t test was used to compare continuous numeric parameters, while a Chi-square test was used for the proportional parameters. Statistical significance was set at P value less than 0.05 for all analyses. RESULTS The mean age at operation, sex, body mass index, and the rate of underlying diabetes were not significantly different between the two groups (P > 0.05 each). Preoperative foot 3D-CT evaluation showed that the rate of large (> 25% of 2nd tarsometatarsal joint involvement), displaced (> 2 mm) fracture fragments on the plantar side of the 2nd metatarsal base was more pronounced in the group with residual diastasis (P = 0.001), while medial wall avulsion of the 2nd metatarsal base was more frequent in the group without residual diastasis (P = 0.001). CONCLUSIONS While treating acute Lisfranc injuries, surgeons should be aware of the presence of a 2nd metatarsal base plantar fracture. A dorsoplantar inter-fragmentary fixation can be considered if the fragment is large and displaced.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Oh Jun Yu
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea.
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Slater JB, Skalski MR. Presentation of a Lisfranc Injury to a Chiropractic Clinic: A Case Report. J Chiropr Med 2022; 21:316-321. [DOI: 10.1016/j.jcm.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/28/2022] Open
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Levy CJ, Yatsonsky D, Moral MZ, Liu J, Ebraheim NA. Arthrodesis or Open Reduction Internal Fixation for Lisfranc Injuries: A Meta-analysis. Foot Ankle Spec 2022; 15:179-184. [PMID: 33269645 DOI: 10.1177/1938640020971419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The purpose of this study is to determine if arthrodesis, compared with open reduction and internal fixation (ORIF), produces favorable American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores, and to determine if differences in complication, revision surgery, and secondary arthrodesis rates exist for patients with Lisfranc fracture/dislocation injuries. Searches were performed in PubMed using the keywords "Lisfranc fracture," "metatarsal fracture," "ORIF," "open reduction internal fixation," "arthrodesis," and "fusion." These criteria left 183 articles for review. Exclusions left 21 articles and 2 translations of Chinese abstracts. Data analysis was performed using Student's 2-sample t test for samples of equal variance, and chi-square test for goodness of fit. The t test revealed a significant difference (P = .03) between the average AOFAS score for patients who underwent primary arthrodesis (84.7 ± 6.14) compared with those who were treated with ORIF (78.9 ± 5.09). There was no significant difference for the average VAS scores (P = .33) of the arthrodesis and ORIF groups. The complication rate of arthrodesis patients was significantly lower than ORIF patients (P = .04), and the rates of revision surgery (P = .22) and secondary arthrodesis (P = .53) were not significant between the groups. The results of this study indicate that arthrodesis may be a better surgical option than ORIF, due to the higher functional scores and the lower complication rate.Levels of Evidence: Level III: A meta-analysis.
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Affiliation(s)
| | - David Yatsonsky
- College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio (CJL) and Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Muhammad Z Moral
- College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio (CJL) and Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Jiayong Liu
- College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio (CJL) and Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
| | - Nabil A Ebraheim
- College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio (CJL) and Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, Ohio
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Stødle AH, Hvaal KH, Brøgger H, Madsen JE, Husebye EE. Outcome after nonoperative treatment of stable Lisfranc injuries. A prospective cohort study. Foot Ankle Surg 2022; 28:245-250. [PMID: 33832813 DOI: 10.1016/j.fas.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the outcome after nondisplaced and stable Lisfranc injuries. METHODS 26 patients with injuries to the Lisfranc joint complex detected on CT scans, but without displacement were tested to be stable using a fluoroscopic stress test. The patients were immobilized in a non-weightbearing short leg cast for 6 weeks. The final follow-up was 55 (IQR 53-60) months after injury. RESULTS All the Lisfranc injuries were confirmed to be stable on follow-up weightbearing radiographs at a minimum of 3 months after injury. Median American Foot and Ankle Society (AOFAS) midfoot score at 1-year follow-up was 89 (IQR 84-97) and at final follow-up 100 (IQR 90-100); The AOFAS score continued to improve after 1-year (P=.005). The median visual analog scale (VAS) for pain was 0 (IQR 0-0) at the final follow-up. One patient had radiological signs of osteoarthritis at 1-year follow-up. CONCLUSION Stable Lisfranc injuries treated nonoperatively had an excellent outcome in this study with a median follow-up of 55 months. The AOFAS score continued to improve after 1 year.
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Affiliation(s)
- Are H Stødle
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
| | - Kjetil H Hvaal
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway
| | - Helga Brøgger
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Jan Erik Madsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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12
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Won HJ, Oh CS. Classification of the interosseous tarsometatarsal ligaments of the foot. Foot Ankle Surg 2022; 28:72-78. [PMID: 33574006 DOI: 10.1016/j.fas.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to clarify the anatomical features of the interosseous tarsometatarsal ligaments of foot and to classify their types based on the combinations of their ligamentous components. METHODS Fifty feet from 27 adult Korean cadavers were dissected. RESULTS The interosseous tarsometatarsal ligaments were observed in the first, second, and third cuneometatarsal joint spaces. The interosseous tarsometatarsal ligament of the first cuneometatarsal space consistently connected the medial cuneiform and the second metatarsal, and was accompanied by one or two accessory ligaments above (34%) and/or below (6%) the Lisfranc ligament. The interosseous tarsometatarsal ligaments of the second and third cuneometatarsal joint spaces comprised seven and five components, and were classified into five and three types depending on the number and combination of the components, respectively. CONCLUSIONS These results are expected to advance the current knowledge on the tarsometatarsal joint and provide helpful information for more accurate and successful diagnosis and treatment of lesions at this joint.
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Affiliation(s)
- Hyung-Jin Won
- Department of Anatomy, School of Medicine, Kangwon National University, Chuncheon, Kangwon-do 24341, Republic of Korea
| | - Chang-Seok Oh
- Department of Anatomy, Sungkyunkwan University School of Medicine, Jangan-gu, Suwon, Gyeonggi-do 440-746, Republic of Korea.
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13
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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] [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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14
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Cottom JM, Graney CT, Sisovsky C. Treatment of Lisfranc Injuries Using Interosseous Suture Button: A Retrospective Review of 84 Cases With a Minimum 3-Year Follow-Up. J Foot Ankle Surg 2021; 59:1139-1143. [PMID: 32830017 DOI: 10.1053/j.jfas.2019.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/30/2019] [Accepted: 12/26/2019] [Indexed: 02/03/2023]
Abstract
Lisfranc fracture dislocation is an injury often encountered by the foot and ankle surgeon. This injury, depending on the severity and level of energy, has been shown to lead to posttraumatic osteoarthritis and chronic pain if undiagnosed or improperly managed. The purpose of this study was to retrospectively evaluate the surgical repair with the use of an interosseous suture button for Lisfranc injuries with isolated ligamentous disruption. From 2008 through 2016, 104 patients were consecutively enrolled who underwent open reduction internal fixation (ORIF) of the Lisfranc complex with a suture button and stabilization of the medial and intermediate cuneiform with a 4.0-mm screw. Eighty-four patients were available for a 3-year minimum follow-up. The mean return to full weightbearing was 11 days protected in a controlled ankle motion (CAM) boot. American Orthopedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scores improved from 30 and 8.4, respectfully, preoperatively to 90 and 1.3 postoperatively. The mean preoperative step-off between the second metatarsal base and intermediate cuneiform was found to be 3.15 mm. The immediate postreduction weightbearing radiograph measured 0.25 mm and 0.43 mm at the final follow-up evaluation, a difference that was found to be significant. There were no revision arthrodeses performed and no removal of the suture button during this time period. ORIF using an interosseous suture button appears to have an adequate medium-term patient satisfaction; however, there is evidence of minimal diastasis in some patients at 3 years postoperatively in ligamentous Lisfranc fracture dislocations.
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Affiliation(s)
- James M Cottom
- Fellowship Trained Foot and Ankle Surgeon and Director, Florida Orthopedic Foot & Ankle Center Fellowship, Sarasota, FL.
| | - Colin T Graney
- Fellow, Florida Orthopedic Foot & Ankle Center Fellowship, Sarasota, FL
| | - Charles Sisovsky
- Fellow, Florida Orthopedic Foot & Ankle Center Fellowship, Sarasota, FL
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15
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Mosca M, Fuiano M, Censoni D, Marcheggiani Muccioli GM, Roberti di Sarsina T, Grassi A, Caravelli S, Zaffagnini S. A mid-term follow-up retrospective evaluation of tarsometatarsal joint fracture-dislocations treated by closed reduction and percutaneous K-wires fixation. Injury 2021; 52:1635-1640. [PMID: 33070946 DOI: 10.1016/j.injury.2020.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/22/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Injuries involving the tarsometatarsal (TMT) joint are relatively uncommon, and the surgical treatment is potentially characterized by a high complications rate. The purpose of this study is to evaluate the results of the treatment of Lisfranc fracture-dislocations treated with closed reduction and percutaneous fixation with K-wires, considering complications and re-intervantion rate. MATERIALS AND METHODS A retrospective review was performed on all patients undergone closed reduction and percutaneous fixation with K-wires of a Lisfranc fracture-dislocation. Patients have been clinically evaluated at last follow up by American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and Visual Analogue Scale (VAS), as well as by radiograph assessment. RESULTS Following inclusion and exclusion criteria, 15 patients have been included, with a mean age of 48.2 ± 5.6 years. Average follow-up was 3.8 ± 1.8 years (range 1-6). 7 fractures analyzed were classified as type A, 7 as type B (3 were B1, 4 were B2) and 1 as type C1. No case of loss of reduction has been observed at radiographic 1-month follow-up. At last follow-up mean AOFAS midfoot score and VAS score were respectively 82.2 ± 10.4 and 1.5 ± 1.3. Registered complications showed one deep vein thrombosis and 2 cases of complex regional pain syndrome (CRPS). One patient subsequently underwent arthrodesis of the tarsometatarsal joint for post-traumatic arthritis. CONCLUSIONS The treatment of the fracture-dislocations of the Lisfranc joint by percutaneous reduction and fixation with K-wire can achieve good clinical outcomes with a low rate of complications and reoperations. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Censoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulio Maria Marcheggiani Muccioli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Dipartimento Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna-Alma Mater Studiorum, Bologna, Italy
| | | | - Alberto Grassi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Stefano Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Dipartimento Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna-Alma Mater Studiorum, Bologna, Italy
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16
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Rhodes D, Leather M, Parker R. Case Study: The Conservative Management of a Complex Mid Foot Injury in an Elite Professional Footballer. Res Sports Med 2021; 30:415-424. [PMID: 33663314 DOI: 10.1080/15438627.2021.1895785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lisfranc injuries, often accompanied with tarsometatarsal joint (TMTJ) disruption, are not well documented in football despite becoming increasingly more prevalent within other athletic populations. Currently there is a paucity of evidence documenting prognosis, rehabilitation strategy and outcome. The presented case summarizes the conservative rehabilitation and return to play of a 26-year-old elite professional footballer who presented with a Lisfranc injury alongside a 3rd TMTJ coalition stress response. Injury was sustained when landing awkwardly from a jump causing the midfoot to be forced into a hyper-plantarflexed position. Palpation identified tenderness over the 2nd and 3rd MT, with a positive piano key test. Magnetic resonance imaging (MRI), computed tomography (CT), stork view x-ray and review from a leading foot and ankle specialist confirmed diagnosis, post-contradictory MRI results. Presented is a summary of the assessment process, conservative management of the injury and the resultant rehabilitation process followed, which led to the successful return to play of the athlete.
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Affiliation(s)
- David Rhodes
- Institute of Coaching and Performance (ICaP), School of Sport and Health Sciences, University of Central Lancashire, Preston, Lancashire, UK
| | - Mark Leather
- School of Sport and Health Sciences, University of Central Lancashire, Preston, Lancashire, UK
| | - Russell Parker
- Medical and Science Department, Rangers Football Centre, Glasgow, Scotland
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17
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Li X, Jia LS, Li A, Xie X, Cui J, Li GL. Clinical study on the surgical treatment of atypical Lisfranc joint complex injury. World J Clin Cases 2020; 8:4388-4399. [PMID: 33083398 PMCID: PMC7559651 DOI: 10.12998/wjcc.v8.i19.4388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/20/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lisfranc injuries have not received much attention by orthopedic doctors in the past, and there is little related research on the diagnosis and treatment of these injuries. In recent years with the rise in foot and ankle surgery, doctors are now paying more attention to this type of injury. However, there is still a high rate of missed diagnosis due to insufficient attention causing treatment delays or inadequate treatments, which eventually result in greater sequelae; including long-term pain, arthritis, foot deformity etc. In particular, for cases with a mild Lisfranc joint complex injury, the incidence of sequelae is higher.
AIM To select an active surgical treatment for an atypical Lisfranc joint complex injury and to evaluate the clinical efficacy of the surgical treatment.
METHODS The clinical data of 18 patients, including 10 males and 8 females aged 20-64 years with Lisfranc injuries treated in our department from January 2017 to September 2019 were retrospectively analyzed. All patients were treated with an open reduction and internal fixation method using locking titanium mini-plates and hollow screws or Kirschner wires. X-ray images were taken and follow-up was performed monthly after the operation; the internal fixation was then removed 4-5 mo after the operation; and the American Orthopedic Foot and Ankle Society (AOFAS) score was used for evaluation on the last follow-up.
RESULTS All patients were followed up for 6-12 mo. A good/excellent AOFAS score was observed in 88.9% of patients.
CONCLUSION For atypical Lisfranc joint complex injuries, active open reduction and internal fixation can be performed to enable patients to obtain a good prognosis and satisfactory functional recovery.
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Affiliation(s)
- Xu Li
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Le-Sheng Jia
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Ang Li
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Xin Xie
- Department of Functional Experiment Center, Liaoning University of Traditional Chinese Medicine, Shenyang 110847, Liaoning Province, China
| | - Jun Cui
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
| | - Guo-Liang Li
- Department of Foot and Ankle Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang 110024, Liaoning Province, China
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18
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Flexible fixation for ligamentous lisfranc injuries. Injury 2019; 50:2123-2127. [PMID: 31378546 DOI: 10.1016/j.injury.2019.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/05/2019] [Accepted: 07/21/2019] [Indexed: 02/02/2023]
Abstract
Lisfranc injuries require anatomic reduction and stabilization of the tarsometatarsal joints. We describe a novel technique that provides flexible fixation that is simple, cost-effective and that may offer certain advantages over more traditional techniques.
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19
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Abstract
Injuries to the Lisfranc complex range from purely ligamentous disruptions to fracture-dislocations of the tarsometatarsal joint. Treatment options include closed/open reduction with percutaneous pinning, open reduction and internal fixation (ORIF), and primary arthrodesis. We present a ligament reinforcement technique utilizing a flexible fixation device for the treatment of ligamentous Lisfranc injuries. Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Connor Delman
- Department of Orthopedics, University of California, Davis, Sacramento, CA, USA
| | - Midhat Patel
- Department of Orthopedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Mark Campbell
- The CORE Institute-Center for Orthopedic Research and Education, Phoenix, AZ, USA
| | - Christopher Kreulen
- Department of Orthopedics, University of California, Davis, Sacramento, CA, USA
| | - Eric Giza
- Department of Orthopedics, University of California, Davis, Sacramento, CA, USA
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20
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Robertson GAJ, Ang KK, Maffulli N, Keenan G, Wood AM. Return to sport following Lisfranc injuries: A systematic review and meta-analysis. Foot Ankle Surg 2019; 25:654-664. [PMID: 30321929 DOI: 10.1016/j.fas.2018.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Information regarding return rates (RR) and mean return times (RT) to sport following Lisfranc injuries remains limited. METHODS A systematic search of nine major databases was performed to identify all studies which recorded RR or RT to sport following lisfranc injuries. RESULTS Seventeen studies were included (n=366). For undisplaced (Stage 1) injuries managed nonoperatively (n=35), RR was 100% and RT was 4.0 (0-15) wks. For stable minimally-displaced (Stage 2) injuries managed nonoperatively (n=16), RR was 100% and RT was 9.1 (4-14) wks. For the operatively-managed injuries, Percutaneous Reduction Internal Fixation (PRIF) (n=42), showed significantly better RR and RT compared to both: Open Reduction Internal Fixation (ORIF) (n=139) (RR - 98% vs 78%, p<0.019; RT - 11.6 wks vs 19.6 wks, p<0.001); and Primary Partial Arthrodesis (PPA) (n=85) (RR - 98% vs 85%, p<0.047; RT - 11.6 wks vs 22.0 wks, p<0.002). CONCLUSIONS Stage 1 and stable Stage 2 Lisfranc injuries show good results with nonoperative management. PRIF offers the best RR and RT from the operative methods, though this may not be possible with high-energy injuries. LEVEL OF EVIDENCE IV. Systematic Review of Level I to Level IV Studies.
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Affiliation(s)
- Gregory Aidan James Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, United Kingdom.
| | - Kok Kiong Ang
- Edinburgh Medical School, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Nicola Maffulli
- Queen Mary University of London, Mile End Road, London E1 4NS, United Kingdom
| | - Gary Keenan
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, United Kingdom
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21
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Won H, Oh C. Variations of the plantar tarsometatarsal ligaments. Clin Anat 2019; 32:699-705. [DOI: 10.1002/ca.23376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Hyung‐Jin Won
- Department of AnatomySchool of Medicine, Kangwon National University Chuncheon Korea
| | - Chang‐Seok Oh
- Department of AnatomySungkyunkwan University School of Medicine Suwon Gyeonggi‐do Korea
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22
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Ponkilainen VT, Laine HJ, Mäenpää HM, Mattila VM, Haapasalo HH. Incidence and Characteristics of Midfoot Injuries. Foot Ankle Int 2019; 40:105-112. [PMID: 30269512 DOI: 10.1177/1071100718799741] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: The epidemiology of midfoot injuries is poorly known. It has been estimated that the incidence of Lisfranc injuries (intra-articular injury in the tarsometatarsal joint) is 1/55 000 person-years and the incidence of Chopart injuries (intra-articular injury in the talonavicular and calcaneocuboidal joint) 4/100 000 person-years. The purpose of our study was to assess the computed tomography (CT) imaging-based incidence (per 100 000 person-years) and trauma mechanisms of midfoot injuries. METHODS: All CT studies performed due to acute injury of the foot and ankle region between January 1, 2012, and December 31, 2016, at Tampere University Hospital were reviewed. Patients presenting with an injury in the midfoot region in the CT scan were included in this study, and their records were retrospectively evaluated to assess patient characteristics. RESULTS: During the 5-year study period, 953 foot and ankle CT scans were obtained because of an acute injury of the foot and ankle. Altogether, 464 foot injuries were found. Of these, 307 affected the midfoot area: 233 (75.9%) the Lisfranc joint area, 56 (18.2%) the Chopart joint area, and 18 (5.9%) were combined injuries or miscellaneous injuries in the midfoot. The incidence of all midfoot injuries was 12.1/100 000 person-years. The incidence of Lisfranc injuries was 9.2/100 000 person-years. The incidence of Chopart injuries was 2.2/100 000 person-years. CONCLUSIONS: The incidence of Lisfranc injuries was higher and the incidence of Chopart injuries lower than previously estimated. More than two-thirds of the midfoot injuries in this study were nondisplaced (<2 mm displacement in fracture or joint) and were caused by low-energy trauma. LEVEL OF EVIDENCE: Level III, epidemiologic study.
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Affiliation(s)
| | - Heikki-Jussi Laine
- 2 Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Heikki M Mäenpää
- 2 Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- 1 School of Medicine, University of Tampere, Tampere, Finland.,2 Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland.,3 COXA Hospital for Joint Replacement, Tampere, Finland
| | - Heidi H Haapasalo
- 2 Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
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23
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Barnds B, Tucker W, Morris B, Tarakemeh A, Schroeppel JP, Mullen S, Vopat BG. Cost comparison and complication rate of Lisfranc injuries treated with open reduction internal fixation versus primary arthrodesis. Injury 2018; 49:2318-2321. [PMID: 30314633 DOI: 10.1016/j.injury.2018.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Controversy exists regarding optimal primary management of Lisfranc injuries. Whether open reduction internal fixation (ORIF) or primary arthrodesis is superior remains unknown. METHODS A national insurance database of approximately 23.5 million orthopedic patients was retrospectively queried for subjects who were diagnosed with a Lisfranc injury from 2007 to 2016 based on international classification of diseases (ICD) codes (PearlDiver, Colorado Springs, CO). Patients with lisfranc injuries then progressed to either nonoperative treatment, ORIF, or primary arthrodesis. Associated treatment costs were determined along with complication rate and hardware removal rate. RESULTS 2205 subjects with a diagnosis of Lisfranc injury were identified in the database. 1248 patients underwent nonoperative management, 670 underwent ORIF, and 212 underwent primary arthrodesis. The average cost of care associated with primary arthrodesis was greater ($5005.82) than for ORIF ($3961.97,P = 0.045). The overall complication rate was 23.1% (155/670) for ORIF and 30.2% (64/212) for primary arthrodesis (P = 0.04). Rates of hardware removal were 43.6% (292/670) for ORIF and 18.4% (39/212) for arthrodesis (P < 0.001). Furthermore, 2.5% (17/670) patients in the ORIF group progressed to arthrodesis at a mean of 308 days, average cost of care associated with this group of patients was $9505.12. DISCUSSION Primary arthrodesis is both significantly more expensive and has a higher complication rate than ORIF. Open reduction and internal fixation demonstrated a low rate of progression to arthrodesis, although there was a high rate of hardware removal, which may represent a planned second procedure in the management of a substantial number of patients treated with ORIF. LEVEL OF EVIDENCE Level III Retrospective Cohort Study.
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Affiliation(s)
- Brandon Barnds
- The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States.
| | - William Tucker
- The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States
| | - Brandon Morris
- The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States
| | - Armin Tarakemeh
- The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States
| | - John Paul Schroeppel
- The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States
| | - Scott Mullen
- The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States
| | - Bryan G Vopat
- The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States
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24
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Won H, Oh C, Yoon Y. Morphologic variations of the dorsal tarsometatarsal ligaments of the foot. Clin Anat 2018; 32:212-217. [DOI: 10.1002/ca.23282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Hyung‐Jin Won
- Department of AnatomySchool of Medicine, Kangwon National University Chuncheon South Korea
| | - Chang‐Seok Oh
- Department of AnatomySungkyunkwan University School of Medicine Suwon South Korea
| | - Young‐Cheol Yoon
- Department of RadiologySamsung Medical Center, Sungkyunkwan University School of Medicine Seoul South Korea
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Abstract
UNLABELLED This study evaluates the midterm outcomes of Lisfranc injuries in adolescents operatively treated with Kirschner wire or screw fixation. Eight adolescent patients with Lisfranc injuries operatively treated in a single institution were included in this study. The mean duration of follow-up was 3.8 years. Analysis of radiographs with respect to the degree of initial displacement and final reduction was carried out in terms of the intermetatarsal distances. All cases were scored functionally using the American Orthopaedic Foot and Ankle Society Midfoot Scale. We concluded that most operatively treated cases of adolescent Lisfranc injuries will do well at the midterm follow-up, with a mean American Orthopaedic Foot and Ankle Society Midfoot score of 93.4. LEVEL OF EVIDENCE Level 4 (Case series).
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26
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Ponkilainen VT, Mattila VM, Laine HJ, Paakkala A, Mäenpää HM, Haapasalo HH. Nonoperative, open reduction and internal fixation or primary arthrodesis in the treatment of Lisfranc injuries: a prospective, randomized, multicenter trial - study protocol. BMC Musculoskelet Disord 2018; 19:301. [PMID: 30126393 PMCID: PMC6102864 DOI: 10.1186/s12891-018-2222-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 08/03/2018] [Indexed: 01/07/2023] Open
Abstract
Background Lisfranc injuries are known to be rare and often overlooked injuries that can cause long-term disability and pain when missed or treated incorrectly. The wide variety of Lisfranc injuries ranges from subtle ligament distensions to open fracture dislocations. The treatment of Lisfranc joint injuries is still controversial and very little is known about what types of injury can be treated nonoperatively. The current literature provides only two randomized studies on dislocated Lisfranc injuries. These studies have shown that primary arthrodesis (PA) leads to a similar or better outcome and results in fewer secondary operations when compared with open reduction and internal fixation (ORIF) in ligamentous injuries. There have been no previous randomized studies of the nonoperative versus operative treatment of Lisfranc injuries. Therefore, the purpose of this study is to compare the operative and nonoperative treatment of non-dislocated Lisfranc injuries and to compare the ORIF and PA treatment of dislocated Lisfranc injuries. Methods This study is a prospective, randomized, national multi-center trial. The trial comprises two strata: Stratum I compares cast-immobilization versus open reduction and internal fixation (ORIF) treatment of non-dislocated Lisfranc joint injuries. Stratum II compares PA versus ORIF in the treatment of dislocated injuries of the Lisfranc joint. The main hypothesis of stratum I is that the nonoperative treatment of non-dislocated Lisfranc injuries achieves a similar outcome compared with operative treatment (ORIF). The hypothesis of stratum II is that PA of dislocated Lisfranc injuries yields a similar functional outcome compared with ORIF, but that PA results in fewer secondary operations than ORIF. The main outcome measure is the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot score and the secondary outcome measures are Visual-Analogue-Scale Foot and Ankle (VAS-FA), Visual-Analogue-Scale (VAS), rate of secondary operations and other treatment-related complications. The results will be analyzed after the 2-year follow-up period. Discussion This publication presents a prospective, randomized, national multi-center trial study protocol. It provides details of patient flow, randomization, aftercare and methods of analysis of the material and ways to present and publish the results. Trial registration ClinicalTrials.gov identifier: NCT02953067 24.10.2016.
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Affiliation(s)
| | - Ville M Mattila
- University of Tampere, School of Medicine, 33520, Tampere, Finland.,Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland.,COXA Hospital for Joint Replacement, Biokatu 6, 33520, Tampere, Finland
| | - Heikki-Jussi Laine
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Antti Paakkala
- Department of Radiology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Heikki M Mäenpää
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Heidi H Haapasalo
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
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Kirzner N, Zotov P, Goldbloom D, Curry H, Bedi H. Dorsal bridge plating or transarticular screws for Lisfranc fracture dislocations: a retrospective study comparing functional and radiological outcomes. Bone Joint J 2018; 100-B:468-474. [PMID: 29629578 DOI: 10.1302/0301-620x.100b4.bjj-2017-0899.r2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Aims The aim of this retrospective study was to compare the functional and radiological outcomes of bridge plating, screw fixation, and a combination of both methods for the treatment of Lisfranc fracture dislocations. Patients and Methods A total of 108 patients were treated for a Lisfranc fracture dislocation over a period of nine years. Of these, 38 underwent transarticular screw fixation, 45 dorsal bridge plating, and 25 a combination technique. Injuries were assessed preoperatively according to the Myerson classification system. The outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) score, the validated Manchester Oxford Foot Questionnaire (MOXFQ) functional tool, and the radiological Wilppula classification of anatomical reduction. Results Significantly better functional outcomes were seen in the bridge plate group. These patients had a mean AOFAS score of 82.5 points, compared with 71.0 for the screw group and 63.3 for the combination group (p < 0.001). Similarly, the mean Manchester Oxford Foot Questionnaire score was 25.6 points in the bridge plate group, 38.1 in the screw group, and 45.5 in the combination group (p < 0.001). Functional outcome was dependent on the quality of reduction (p < 0.001). A trend was noted which indicated that plate fixation is associated with a better anatomical reduction (p = 0.06). Myerson types A and C2 significantly predicted a poorer functional outcome, suggesting that total incongruity in either a homolateral or divergent pattern leads to worse outcomes. The greater the number of columns fixed the worse the outcome (p < 0.001). Conclusion Patients treated with dorsal bridge plating have better functional and radiological outcomes than those treated with transarticular screws or a combination technique. Cite this article: Bone Joint J 2018;100-B:468-74.
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Affiliation(s)
- N Kirzner
- Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, OrthoSports Victoria, Level 5, 89 Bridge Rd, Richmond, Victoria 312, Australia
| | - P Zotov
- Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, OrthoSports Victoria, Level 5, 89 Bridge Rd, Richmond, Victoria 312, Australia
| | - D Goldbloom
- Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, OrthoSports Victoria, Level 5, 89 Bridge Rd, Richmond, Victoria 312, Australia
| | - H Curry
- Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, OrthoSports Victoria, Level 5, 89 Bridge Rd, Richmond, Victoria 312, Australia
| | - H Bedi
- Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, OrthoSports Victoria, Level 5, 89 Bridge Rd, Richmond, Victoria 312, Australia
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Rozell JC, Chin M, Donegan DJ, Hast MW. Biomechanical Comparison of Fully Threaded Solid Cortical Versus Partially Threaded Cannulated Cancellous Screw Fixation for Lisfranc Injuries. Orthopedics 2018; 41:e222-e227. [PMID: 29309714 DOI: 10.3928/01477447-20180103-03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/30/2017] [Indexed: 02/03/2023]
Abstract
There currently exists an array of operative strategies to manage Lisfranc injuries. Modular fixation systems present surgeons with a choice between fully threaded solid cortical (FSC) and partially threaded cannulated cancellous (PCC) bone screws when using a transarticular screw approach. It is currently unknown how screw design influences fixation strength in Lisfranc reconstructions. The purpose of this study was to evaluate the biomechanical differences of FSC and PCC screws using a cadaveric model of a simulated Lisfranc injury and controlled benchtop experiments. Ten matched pairs of cadaveric feet received an acute Lisfranc injury and were repaired with FSC or PCC screws. Diastasis was measured between the medial and intermediate cuneiforms and the first and second metatarsals during simulations of partial weight bearing. Three-point bending and axial pull-out tests were performed to characterize screw mechanics that could not be measured within the cadaveric model. Screw design did not affect cuneiform or metatarsal diastasis. Neither screw loosening nor deformation was observed following cadaveric testing. Bending tests indicated FSC screws had higher ultimate strength, but there was no significant difference in yield load. Partially threaded cannulated cancellous bone screws exhibited superior axial pull-out strength. Fully threaded solid cortical and PCC screws provide equal amounts of fixation strength during partial weight bearing and similar resistance to deformation under bending loads. Partially threaded cannulated cancellous screws may simplify the operative procedure and minimize nonoptimal screw placement. If a clinician so desires, PCC screws may be used in lieu of FSC screws without sacrificing fixation strength. [Orthopedics. 2018; 41(2):e222-e227.].
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Seo DK, Lee HS, Lee KW, Lee SK, Kim SB. Nonweightbearing Radiographs in Patients With a Subtle Lisfranc Injury. Foot Ankle Int 2017; 38:1120-1125. [PMID: 28708955 DOI: 10.1177/1071100717717220] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A midfoot sprain can be easily missed because of minimal findings on initial radiographs, which are almost universally nonweightbearing. We investigated preoperative nonweightbearing plain radiographic images in patients who were found to have unstable subtle Lisfranc injuries. METHODS We retrospectively reviewed 51 patients who were operated on between February 2004 and March 2015. Abnormal preoperative radiographic findings and intraoperative instability were compared. The relationship was calculated with Fisher's exact test. RESULTS Based on intraoperative findings, medial cuneiform (C1)-second metatarsal (M2) instability was observed in 50 cases (98%), which was the most common. Thirty-nine cases (76.4 %) had multiple joint (at least 2) instability. In the preoperative radiologic findings, C1-M2 diastasis was the most common abnormal finding, in 46 cases (90.1%). Specificity and positive predictive value were 1.0 in C1-M2 avulsion, diastasis, and C1-intermediate cuneiform (C2) diastasis. Abnormal findings of C1-C2, C1-M1, and C2-M2 showed a significant relationship with intraoperative instability ( P < .05). CONCLUSION C1-M2 avulsion and diastasis and C1-C2 diastasis were definite preoperative predictors of instability. In unstable subtle Lisfranc injuries, 90% had at least a minor radiographic abnormality at the C1-M2 joint on nonweightbearing radiographs. However, caution should be exercised to identify instability without radiographic abnormality in the C1-M2 joint. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Dong-Kyo Seo
- 1 Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Ho-Seong Lee
- 2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Ki Won Lee
- 1 Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Suk Kyu Lee
- 1 Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
| | - Sang-Bum Kim
- 1 Department of Orthopedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, GangNeung-si, South Korea
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Vosbikian M, O'Neil JT, Piper C, Huang R, Raikin SM. Outcomes After Percutaneous Reduction and Fixation of Low-Energy Lisfranc Injuries. Foot Ankle Int 2017; 38:710-715. [PMID: 28481627 DOI: 10.1177/1071100717706154] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lisfranc injuries are often missed initially or not anatomically reduced, leading to midfoot collapse, arthrosis, and pain. Operative management of these injuries is also fraught with complications, particularly with respect to the soft tissues. Wound dehiscence and infection are not uncommon. The goal of this study was to analyze the outcomes of a minimally invasive technique in reduction and percutaneous fixation of low-energy minimally displaced Lisfranc injuries and determine if it is a safe alternative to more traditional, open approaches. METHODS A retrospective review was performed for all patients who underwent minimally invasive Lisfranc treatment at a single institution over a 6-year period. Thirty-eight patients were identified in this series. All patients were skeletally mature and had a minimum follow-up of 3 years. Patients were assessed clinically and radiographically, in addition to undertaking patient-centric outcome scoring using the Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL) and sports subscales at a mean follow-up of 66 months (range, 36-100). Patients were also asked to subjectively rate their percentage return to preinjury functional level at the time of final follow-up. There were 20 males and 18 females. Seventeen patients were injured participating in sports-related activities, 19 during falls, and 2 as a result of motor vehicle accidents. The average age at the time of surgery was 34.2 (range, 16-69) years. At final follow-up, 31 patients were available for assessment (81.6%). RESULTS The mean FAAM-ADL score was 94.2 (range, 40.5-100), and sports score was 90.4 (range, 0-100). Percentage recovery compared to their preinjury functional level averaged 91.4% (range, 40%-100%). There were no complications in this series. Twenty-two patients underwent screw removal electively at an average of 6.9 months following the index procedure. No patients had undergone any additional operative procedures, or had any objective evidence of midfoot collapse or arthritis at the time of final follow-up. CONCLUSION Minimally invasive methods of treating low-energy Lisfranc injuries with less soft tissue stripping and disruption, as described in this series, were a valuable tool to optimize outcomes while minimizing the potential morbidity of more traditional, open techniques. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Michael Vosbikian
- 1 Department of Orthopaedic Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Joseph T O'Neil
- 2 Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christine Piper
- 3 Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA
| | - Ronald Huang
- 2 Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Steven M Raikin
- 4 Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Lau SC, Guest C, Hall M, Tacey M, Joseph S, Oppy A. Do columns or sagittal displacement matter in the assessment and management of Lisfranc fracture dislocation? An alternate approach to classification of the Lisfranc injury. Injury 2017; 48:1689-1695. [PMID: 28390686 DOI: 10.1016/j.injury.2017.03.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 02/02/2023]
Abstract
AIM The classification of a Lisfranc injury has conventionally been based around Myerson's system. The aims of this study were to review whether a novel classification system based on sagittal displacement of the tarsometatarsal joint and breadth of injury as determined by a columnar theory was associated with functional outcomes and thus had a greater utility. PATIENTS We retrospectively reviewed 54 Lisfranc injuries with a minimum follow up of two years at our Level One Trauma Centre. Each fracture was sub-classified based on our novel classification system which assessed for evidence of sagittal displacement and involvement of columns of the midfoot. Our primary outcome measures were the FFI and AOFAS midfoot scores. RESULTS Injuries involving all three of the columns of the midfoot were associated with significantly worse functional outcome scores (FFI p=0.004, AOFAS p=0.036). Conversely, sagittal displacement, whether dorsal or plantar, had no significance (FFI p=0.147, AOFAS p=0.312). The best predictor of outcome was the quality of anatomical reduction (FFI p=0.008, AOFAS p=0.02). CONCLUSION Column involvement and not sagittal displacement is the most significant factor in considering the severity Lisfranc injury and long term functional outcomes. This classification system has greater clinical utility than those currently proposed.
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Affiliation(s)
- Simon C Lau
- Department of Orthopaedics, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Catherine Guest
- Department of Orthopaedics, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Marucs Hall
- Monash School Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Tacey
- Melbourne Epicentre, University of Melbourne, Melbourne, Victoria, Australia
| | - Samuel Joseph
- Department of Orthopaedics, Frankston Hospital, Melbourne, Victoria, Australia
| | - Andrew Oppy
- Department of Orthopaedics, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Qiao YS, Li JK, Shen H, Bao HY, Jiang M, Liu Y, Kapadia W, Zhang HT, Yang HL. Comparison of Arthrodesis and Non-fusion to Treat Lisfranc Injuries. Orthop Surg 2017; 9:62-68. [PMID: 28276650 DOI: 10.1111/os.12316] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/28/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE "Lisfranc joint injury" is comprised of a tarsometatarsal joint-complex injury. The Lisfranc complex injury is always a challenge for orthopedists, and the optimum treatment is still up for debate. Anatomic reduction and stable internal fixation prove to have no satisfactory outcomes. This research aims to compare the clinical curative effects, complications and radiographic features of arthrodesis and non-fusion of the Lisfranc joint in the follow-up of the patients who suffered Lisfranc injuries. METHODS A comparative retrospective study of 25 patients with acute or subacute Lisfranc complex injuries was conducted between September 2013 and March 2015 in the First Affiliated Hospital of Soochow University. All patients were classified by Myerson classification. Eight patients were treated with arthrodesis, while 17 patients received non-fusion operations. The clinical curative effects, complications and image differences were compared between the two groups. American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, Short Form-36 (SF-36) and Visual Analogue Scale (VAS) score were evaluated for each patient during the follow-up. All statistics were analyzed using the SPSS software system. RESULTS All fractures healed for both the arthrodesis group and the non-fusion group. Patients in the arthrodesis group had a higher AOFAS score compared with patients in the non-fusion group (94.00 vs. 88.58, P = 0.034). Complications occurred in eight patients (8/17, 47%) in the non-arthrodesis group, including the second and third phalanx abduction (1), talipes cavus (2), eversion deformity of front foot (3), eversion deformity of calcaneus (1), as well as postoperative infection (1). Only two patients (2/8, 25%) in the arthrodesis group suffered complications. One was a limitation of motion of the front foot and pain during walking; the other was an eversion deformity of front foot. CONCLUSION Primary arthrodesis has advantages compared to primary open reduction and internal fixation (ORIF): reduced foot deformity rates, sustained biomechanical morphology of the feet, reduced complications, higher level of function recovery, shorter time of surgical procedures, fewer complications, higher AOFAS score and fewer frequency of complications. According to our research, primary arthrodesis may be a better choice for treating Lisfranc injury.
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Affiliation(s)
- Yu-Sen Qiao
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Jun-Kun Li
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Hao Shen
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Hai-Yan Bao
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Ming Jiang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Yan Liu
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Wasim Kapadia
- Department of Chemical Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Hong-Tao Zhang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China
| | - Hui-Lin Yang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Soochow, China
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Yu X, Pang QJ, Chen XJ. The biomechanical study of the influence to the forefoot plantar pressure of the first tarsometatarsal joint fracture-dislocation fixed by three different implants. Pak J Med Sci 2017; 33:146-150. [PMID: 28367189 PMCID: PMC5368297 DOI: 10.12669/pjms.331.11908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives: To study the influence of forefoot plantar pressure of the first tarsometatarsal joint fracture-dislocation by three different implants to provide experimental reference in selecting implants. Methods: Eight fresh foot specimens were made into the models of the first tarsometatarsal joint fracture-dislocation, which were fixed with 3.5 mm cortical screw, 1/4 tubular plate and compressive staple in turn. After the loading of 600N, the changes of the plantar pressure in forefoot were measured by the method of the F-scan plantar pressure system. Results: After first tarsometatarsal joint fracture-dislocation, the peak pressure under the first metatarsal head would decrease, while the pressure under the second metatarsal head would increase(P<0.05). When the first tarsometatarsal joint was fixed with screw or plate respectively; the peak pressure under the two metatarsal heads would tend to be normal. However, the staple fixation would show the statistical significant difference, although the peak pressure under the first and second metatarsal heads were recovered in some extent(P<0.05). Conclusions: After the first tarsometatarsal joint fracture-dislocation, the plantar pressure might be compensated partly by the adjacent metatarsal heads. While the first tarsometatarsal joint fracture-dislocation was fixed by screw or plate, the plantar pressure of the forefoot would return to the normal state. However, if the joint was fixed by the staple, it would still be difficult to return the plantar pressure to be normal.
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Affiliation(s)
- Xiao Yu
- Dr. Xiao Yu, PhD. Department of Orthopedics, Ningbo NO.2 Hospital, Ningbo, 315010, China
| | - Qing-Jiang Pang
- Dr. Qing-jiang Pang, PhD. Department of Orthopedics, Ningbo NO.2 Hospital, Ningbo, 315010, China
| | - Xian-Jun Chen
- Dr. Xian-jun Chen, MD. Department of Orthopedics, Ningbo NO.2 Hospital, Ningbo, 315010, China
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Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury. Chin J Traumatol 2017; 18:18-20. [PMID: 26169089 DOI: 10.1016/j.cjtee.2014.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. METHODS Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years (mean 32 years). Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents (3 cases), fall from height (5 cases) and hit by heavy object (2 cases). All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days (average 6.6 days). Postoperatively, the foot function was assessed using Visual Analogue Scales (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) Scales. Healing time and complications were observed. RESULTS All patients were followed up for 18-24 months (average 20 months). Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score (7.89 ± 0.34) and score at postoperative 8 weeks (0.67 ± 0.13). According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. CONCLUSION Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients' quality of life.
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Balazs GC, Hanley MG, Pavey GJ, Rue JP. Military personnel sustaining Lisfranc injuries have high rates of disability separation. J ROY ARMY MED CORPS 2016; 163:215-219. [PMID: 27940985 DOI: 10.1136/jramc-2016-000681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/26/2016] [Accepted: 10/23/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Lisfranc injuries are relatively uncommon midfoot injuries disproportionately affecting young, active males. Previous studies in civilian populations have reported relatively good results with operative treatment. However, treatment results have not been specifically examined in military personnel, who may have higher physical demands than the general population. The purpose of this study was to examine rates of return to military duty following surgical treatment of isolated Lisfranc injuries. METHODS Surgical records and radiographic images from all active duty US military personnel treated for an isolated Lisfranc injury between January 2005 and July 2014 were examined. Demographic information, injury data, surgical details and subsequent return to duty information were recorded. The primary outcome was ability to return to unrestricted military duty following treatment. The secondary outcome was secondary conversion to a midfoot arthrodesis following initial open reduction internal fixation. RESULTS Twenty-one patients meeting inclusion criteria were identified. Median patient age was 23 years, and mean follow-up was 43 months. Within this cohort, 14 patients were able to return to military service, while seven required a disability separation from the armed forces. Of the 18 patients who underwent initial fixation, eight were subsequently revised to midfoot arthrodesis for persistent pain. DISCUSSION Military personnel sustaining Lisfranc injuries have high rates of persistent pain and disability, even after optimal initial surgical treatment. Military surgeons should counsel patients on the career-threatening nature of this condition and high rates of secondary procedures.
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Affiliation(s)
- George C Balazs
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - M G Hanley
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - G J Pavey
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - J-Ph Rue
- Department of Orthopaedics and Rehabilitation, United States Naval Academy, Naval Health Clinic Annapolis, Annapolis, Maryland, USA
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Cheung CN, Lui TH. Proximal Fifth Metatarsal Fractures: Anatomy, Classification, Treatment and Complications. ARCHIVES OF TRAUMA RESEARCH 2016; 5:e33298. [PMID: 28144601 PMCID: PMC5251206 DOI: 10.5812/atr.33298] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 03/31/2016] [Accepted: 05/22/2016] [Indexed: 12/21/2022]
Abstract
Context Fractures of proximal fifth metatarsal are one of the most common fractures of the foot. Evidence Acquisition A search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies. Results The vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and non-union in fractures at the metaphyseal-diaphyseal junction. Lawrence and Botte classify proximal fifth metatarsal fractures according to their location: tuberosity avulsion fractures (zone 1), fractures at metaphyseal-diaphyseal junction extending into the fourth-fifth intermetatarsal joint (zone 2) and proximal diaphyseal fractures (zone 3). Zone 1 fractures are treated conservatively with functional immobilization and early mobilization with excellent outcome. For zone 2 and zone 3 fractures, acute forms can be treated conservatively but with a risk of delayed union time and time for return to function. Therefore, early surgical fixation with intramedullary screw is advised in athletic individuals. For cases presented with signs of delayed union and non-union, surgical treatment with or without bone grafting is recommended. Complications of these fractures and their management are discussed in this report. Conclusions Lawrence and Botte’s classification of proximal fifth metatarsal fractures is recommended by experts, due to its implication on prognosis and treatment strategy. Zone 1 fractures should be treated conservatively due to their excellent healing potential. Early operative treatment is advised for zone 2 and zone 3 fractures, especially in the athletic group. Complications of delayed union, non-union and refractures should be treated by revision fixation and bone grafting.
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Affiliation(s)
- Chi Nok Cheung
- Department of Orthopedics and Traumatology, North District Hospital, Hong Kong SAR, China
| | - Tun Hing Lui
- Department of Orthopedics and Traumatology, North District Hospital, Hong Kong SAR, China
- Corresponding author: Tun Hing Lui, Department of Orthopedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China. Tel: +852-26837588, Fax: +852-26837576, E-mail:
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MacMahon A, Kim P, Levine DS, Burket J, Roberts MM, Drakos MC, Deland JT, Elliott AJ, Ellis SJ. Return to Sports and Physical Activities After Primary Partial Arthrodesis for Lisfranc Injuries in Young Patients. Foot Ankle Int 2016; 37:355-62. [PMID: 26596795 DOI: 10.1177/1071100715617743] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research regarding outcomes in sports and physical activities after primary partial arthrodesis for Lisfranc injuries has been sparse. The purposes of this study were to assess various sports and physical activities in young patients following primary partial arthrodesis for Lisfranc injuries and to compare these with clinical outcomes. METHODS Patients who underwent primary partial arthrodesis for a Lisfranc injury were identified by a retrospective registry review. Thirty-eight of 46 eligible patients (83%) responded for follow-up at a mean of 5.2 (range, 1.0 to 9.3) years with a mean age at surgery of 31.8 (range, 16.8 to 50.3) years. Physical activity participation was assessed with a new sports-specific, patient-administered questionnaire. Clinical outcomes were assessed with the Foot and Ankle Outcome Score (FAOS). RESULTS Patients participated in 29 different and 155 total physical activities preoperatively, and 27 different and 145 total physical activities postoperatively. Preoperatively, 47.1% were high impact, and postoperatively, 44.8% were high impact. The most common activities were walking, bicycling, running, and weightlifting. Compared to preoperatively, difficulty was the same in 66% and increased in 34% of physical activities. Participation levels were improved in 11%, the same in 64%, and impaired in 25% of physical activities. Patients spent on average 4.2 (range, 0.0 to 19.8) hours per week exercising postoperatively. In regard to return to physical activity, 97% of respondents were satisfied with their operative outcome. Mean postoperative FAOS subscores were significantly worse for patients who had increased physical activity difficulty. CONCLUSION Most patients were able to return to their previous physical activities following primary partial arthrodesis for a Lisfranc injury, many of which were high-impact. However, the decreased participation or increase in difficulty of some activities suggests that some patients experienced postoperative limitations in exercise. Future studies could compare sports outcomes between primary partial arthrodesis and open reduction internal fixation for Lisfranc injuries. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Aoife MacMahon
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, NY, USA
| | - Paul Kim
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, NY, USA
| | - David S Levine
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, NY, USA
| | - Jayme Burket
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, NY, USA
| | - Matthew M Roberts
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, NY, USA
| | - Mark C Drakos
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, NY, USA
| | - Jonathan T Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, NY, USA
| | - Andrew J Elliott
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, NY, USA
| | - Scott J Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, NY, USA
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Abstract
Lisfranc fracture-dislocations are very serious and potentially disabling injuries. Unfortunately, they are often misdiagnosed. Multiplanar midfoot deformities that result from these fracture-dislocations are precursors of joint degeneration and significant functional disabilities. Anatomic reduction with different types of internal fixation is an efficient method to reconstruct midfoot alignment and stability. Joint-preserving reconstruction techniques emerge as a viable alternative to corrective fusion as they achieve stable joint realignment with preserved motion.
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Affiliation(s)
- Caio Nery
- Albert Einstein Hospital, Foot and Ankle Clinic, Hospital Israelita Albert Einstein, Avenue Albert Einstein, 627, Bloco A1 - 3o andar, sala 317, Morumbi, São Paulo, Brazil; UNIFESP - Federal University of São Paulo - Foot and Ankle Surgery, São Paulo, Brazil.
| | - Fernando Raduan
- Albert Einstein Hospital, Foot and Ankle Clinic, Hospital Israelita Albert Einstein, Avenue Albert Einstein, 627, Bloco A1 - 3o andar, sala 317, Morumbi, São Paulo, Brazil; UNIFESP - Federal University of São Paulo - Foot and Ankle Surgery, São Paulo, Brazil
| | - Daniel Baumfeld
- Hospital Felicio Rocho, Belo Horizonte, Minas Gerais, Brazil; UFMG - Federal University of Minas Gerais - Foot and Ankle Surgery, Minas Gerais, Brazil
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Abstract
Lisfranc injuries are commonly asked about in FRCS Orthopaedic trauma vivas. The term "Lisfranc injury" strictly refers to an injury where one or more of the metatarsals are displaced from the tarsus. The term is more commonly used to describe an injury to the midfoot centred on the 2nd tarsometatarsal joint. The injury is named after Jacques Lisfranc de St. Martin (1790-1847), a French surgeon and gynaecologist who first described the injury in 1815. 'Lisfranc injury' encompasses a broad spectrum of injuries, which can be purely ligamentous or involve the osseous and articular structures. They are often difficult to diagnose and treat, but if not detected and appropriately managed they can cause long-term disability. This review outlines the anatomy, epidemiology, classification, investigation and current evidence on management of this injury.
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Affiliation(s)
- M J Welck
- SpR Trauma and Orthopaedics, Watford General Hospital, United Kingdom.
| | - R Zinchenko
- University College London Medical School, United Kingdom
| | - B Rudge
- Consultant Orthopaedic Surgeon, Watford General Hospital, United Kingdom
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Biomechanical study of tarsometatarsal joint fusion using finite element analysis. Med Eng Phys 2014; 36:1394-400. [PMID: 24768563 DOI: 10.1016/j.medengphy.2014.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/15/2014] [Accepted: 03/26/2014] [Indexed: 11/23/2022]
Abstract
Complications of surgeries in foot and ankle bring patients with severe sufferings. Sufficient understanding of the internal biomechanical information such as stress distribution, contact pressure, and deformation is critical to estimate the effectiveness of surgical treatments and avoid complications. Foot and ankle is an intricate and synergetic system, and localized intervention may alter the functions to the adjacent components. The aim of this study was to estimate biomechanical effects of the TMT joint fusion using comprehensive finite element (FE) analysis. A foot and ankle model consists of 28 bones, 72 ligaments, and plantar fascia with soft tissues embracing all the segments. Kinematic information and ground reaction force during gait were obtained from motion analysis. Three gait instants namely the first peak, second peak and mid-stance were simulated in a normal foot and a foot with TMT joint fusion. It was found that contact pressure on plantar foot increased by 0.42%, 19% and 37%, respectively after TMT fusion compared with normal foot walking. Navico-cuneiform and fifth meta-cuboid joints sustained 27% and 40% increase in contact pressure at second peak, implying potential risk of joint problems such as arthritis. Von Mises stress in the second metatarsal bone increased by 22% at midstance, making it susceptible to stress fracture. This study provides biomechanical information for understanding the possible consequences of TMT joint fusion.
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