Open Reduction Internal Fixation of the Lisfranc Complex

Ankle Arthrodesis in Crippled Cases

The current article provides an algorithm of how to approach crippled ankle by ankle arthrodesis. There is no standard pathology or treatment present, which makes the diagnosis but also surgical correction complex. A surgeon who faces this kind of deformities needs to be skilled and well familiar with the full setting of the foot and ankle armamentarium.

Isolated Medial Cuneiform Fractures: A Systematic Search and Qualitative Analysis of Case Studies

BACKGROUND

Isolated medial cuneiform fracture is a rare but diagnostically challenging condition. Diagnostic delay in these cases may lead to delays in ideal treatment approaches and prolonged symptoms. An understanding of clinical presentation is needed to expedite diagnosis, facilitate decision making, and guide treatment approach.

METHODS

Case studies/series were searched in four databases until September 2019. Included studies had participants with a history of traumatic closed medial cuneiform fracture. Studies were excluded if the medial cuneiform fractures were open fractures, associated with multitrauma, or associated with dislocation/Lisfranc injury. Three blinded reviewers assessed the methodological quality of the studies, and a qualitative synthesis was performed.

RESULTS

Ten studies comprising 15 patients were identified. Mean ± SD patient age was 38.0 ± 12.8 years, with 86.7% of reported participants being men. The overall methodological quality was moderate to high, and reporting of the patient selection criteria was poor overall. The most commonly reported clinical symptoms were localized tenderness (60.0%) and edema (53.3%). Direct blow was the most common inciting trauma (46.2%), followed by axial load (30.8%) and avulsion injuries (23.1%). Baseline radiographs were occult in 72.7% of patients; magnetic resonance imaging and computed tomography were the most common diagnostic modalities. Mean ± SD diagnostic delay was 64.7 ± 89.6 days. Conservative management was pursued in 54.5% of patients, with reported resolution of symptoms in 3 to 6 months. Surgical intervention occurred in 45.5% of patients and resulted in functional restoration in 3 to 6 months in all but one patient.

CONCLUSIONS

Initial radiographs for isolated medial cuneiform fractures are frequently occult. Due to expedience and relatively low cost, radiographs are still a viable first-line imaging modality. If clinical concern remains, magnetic resonance imaging may be pursued to minimize diagnostic delay. Conservative management is a viable treatment method, with expected return to full function in 3 to 6 months.

Sports-Related Lisfranc Injuries and Recognition of Lisfranc Variants: Surgical Strategies for Stabilization

Much has changed since Lisfranc described lesions at the tarsometatarsal (TMT) joint in 1815. What was considered an osseous high-energy condition nowadays is understood as myriad possible presentations, occurring in minor and inconspicuous traumas. Advancements in diagnostics of Lisfranc injury allow recognizing many variants of this trauma presentation, most of them with a focus on ligaments. This perception shifted trends in surgical planning, especially for implants and fixation techniques. These revolutions established a new and evolving universe around TMT lesions, different from what was known only a few years ago and still not enough to completely settle the disease scenario.

Effect of different fusion types on kinematics of midfoot lateral column: a comparative biomechanical study

Background

This study aimed to compare the biomechanical outcomes of the isolated 4^th or 5^th tarsometatarsal (TMT) joint arthrodesis with the whole lateral TMT joints arthrodesis.

Methods

Ten cadaveric lower legs underwent isolated 4^th TMT joint arthrodesis, 5^th TMT joint arthrodesis, and whole lateral TMT joints arthrodesis in sequence. Texson F-scan and K-scanTM joint sensor were used to test the medial and lateral plantar pressure and the pressure of calcaneocuboid joint.

Results

Compared with the intact foot, the lateral forefoot pressure increased significantly (P<0.05) after 4^th TMT joint fusion. The medial forefoot pressure was significantly lower in the 5^th TMT joint fusion than that in the intact foot (P<0.05) and the 4^th TMT joint fusion (P<0.05), but higher than that in the whole lateral TMT joints fusion (P<0.05). On the contrary, the lateral forefoot pressure was significantly higher in the 5^th TMT joint fusion than that in the intact foot and the 4^th TMT joint fusion, but lower than that in the whole lateral TMT joints fusion (P<0.05). The medial forefoot pressure was the lowest (P<0.05) and lateral forefoot pressure was the highest (P<0.05) in the whole lateral TMT joints fusion. The calcaneocuboid joint pressure increased respectively with the intact foot being the lowest, followed by the isolated 4^th TMT joint arthrodesis, the isolated 5^th TMT joint arthrodesis, and the whole lateral TMT joints arthrodesis (P<0.05).

Conclusions

The isolated 4^th or 5^th TMT joint arthrodesis has less impact on the pressure of forefoot and adjacent joints than the whole lateral TMT joints arthrodesis. The isolated 4^th TMT joint arthrodesis has the lowest influence on the pressure of forefoot and adjacent joints.