1
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Lachance AD, Giro ME, Edelstein A, Lee W. Suture button fixation yields high levels of patient reported outcomes, return to sport, and stable fixation in isolated Lisfranc injuries: A systematic review. J ISAKOS 2023; 8:474-483. [PMID: 37611870 DOI: 10.1016/j.jisako.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/23/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Abstract
IMPORTANCE Lisfranc injuries remain a significant, but often misdiagnosed, orthopaedic injury. Alongside the traditional methods of surgical fixation, including arthrodesis and open reduction and internal fixation with screws, suture button fixation is an emerging technique. OBJECTIVES The purpose of this study is to investigate the efficacy of suture button fixation for treatment of Lisfranc injuries through a systematic review. EVIDENCE REVIEW A comprehensive literature review was conducted according to the preferred reporting items for systematic reviews using PubMed, Embase, Web of Science, and Cochrane databases for original, English-language studies observing outcomes of Lisfranc injury until August 19, 2022. The clinical studies with evidence level I-IV and at least a 12 month follow-up after the index surgery were included if they examined quantifiable outcomes of Lisfranc injury treated with suture button. Articles were excluded if they included case reports, systematic reviews, comments, editorials, surveys, animal studies, or biomechanical/cadaveric studies. Variables extracted from text and figures include demographic information, return to sport measures, patient reported outcomes, and complications. FINDINGS Of the 10 studies included, there were 186 total patients with an age range of 13-72. In every study, all patients were able to return to sport or activity with a return time averaging from 10.8 to 25.9 weeks. Postoperative American Orthopaedic Foot and Ankle Society scores ranged from 83.5 to 97.0 while pain Visual Analogue Scale ranged from 0.6 to 2.5. Complications were reported in four studies at a rate of 7.7% including two cases of diastasis, two cases of paraesthesia, one case of button irritation, and one of postoperative degenerative joint disease, with no reported revisions. CONCLUSIONS AND RELEVANCE In our systematic review, suture button fixation shows high levels of patient reported outcomes, return to sport, and stable fixation in isolated Lisfranc injuries. This surgical technique provides a physiologic reduction across the Lisfranc joint and reduces the need for reoperation including removal of hardware. However, further evidence such as large sample size high-quality randomized controlled trials is needed to draw a definitive conclusion regarding the best treatment for Lisfranc injuries. LEVEL OF EVIDENCE Level IV, Systematic Review of Level III and IV studies.
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Affiliation(s)
- Andrew D Lachance
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre, PA, 18840, United States.
| | - Margaret Elizabeth Giro
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre, PA, 18840, United States.
| | - Alexander Edelstein
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre, PA, 18840, United States.
| | - Wonyong Lee
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre, PA, 18840, United States.
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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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3
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Brown CL, James NA, Onyeukwu C, Belayneh R, Boakye L, Hogan MV. Patient-Reported Outcome Measures After Surgical Management of
Unstable Lisfranc Injuries in Athletes. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231160762. [PMID: 36968812 PMCID: PMC10031611 DOI: 10.1177/24730114231160762] [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: 03/24/2023] Open
Abstract
Background: Athletes sustaining Lisfranc joint instability after a low-energy injury
often undergo surgical fixation. Limited studies report validated
patient-reported outcome measures (PROMs) for this specific patient
population. Our purpose was to report PROMs of athletes experiencing
instability after a low-energy Lisfranc injury and undergoing surgical
fixation. Methods: Twenty-nine athletes (23 competitive, 6 recreational) sustained an unstable
Lisfranc injury (14 acute, 15 chronic) and met our inclusion criteria.
Injuries were classified as acute if surgically managed within 6 weeks. All
athletes completed validated PROMs pre- and postoperatively. The cohort
underwent various open reduction internal fixation methods. We evaluated
outcomes with the Foot and Ankle Ability Measure (FAAM) activities of daily
living (ADL) and sports subscales. Results: Fourteen of 29 (48%) athletes reported PROMs at ≥2 years with a median
follow-up time of 44.5 months. Substantial improvement for both FAAM ADL
(50% vs 93%; P < .001) and sports (14.1% vs 80%;
P = .002) subscales were found, when comparing
preoperative to postoperative scores at ≥2 years. Conclusion: This study provides outcomes information for the young athletic population
that were treated operatively for low-energy Lisfranc injury with apparent
joint instability. Based on the FAAM sports subscale, these patients on
average improved between their 6-month evaluation and their final ≥2 years
but still scored 80% of the possible 100%, which indicates continued but
“slight” difficulty with lower extremity function. Level of Evidence: Level IV, case series.
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Affiliation(s)
- Cortez L. Brown
- Department of Orthopaedic Surgery,
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nia A. James
- Department of Orthopaedic Surgery,
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chukwudi Onyeukwu
- Department of Orthopaedic Surgery,
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rebekah Belayneh
- Department of Orthopaedic Surgery,
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lorraine Boakye
- Department of Orthopaedic Surgery,
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - MaCalus V. Hogan
- Department of Orthopaedic Surgery,
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- MaCalus V. Hogan, MD, MBA, Department of
Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth
Ave, Suite 911, Pittsburgh, PA 15213, USA.
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4
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Desai MN, Martin KD. Closed Reduction and Percutaneous Fixation of Lisfranc Injury Using Suspensory Fixation. JBJS Essent Surg Tech 2023; 13:e21.00066. [PMID: 38274284 PMCID: PMC10807883 DOI: 10.2106/jbjs.st.21.00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Background This closed reduction and percutaneous fixation (CRPF) technique utilizing suspensory fixation is indicated for the treatment of Lisfranc injuries with displacement or instability of the tarsometatarsal joint complex-and typically only for low-energy, purely ligamentous Lisfranc injuries. The goal of this procedure is to restore joint stability and prevent common complications of Lisfranc injuries (e.g., midfoot arch collapse and posttraumatic arthritis) while avoiding the complications and risks associated with open reduction and internal fixation (ORIF) and primary arthrodesis. We recommend performing the procedure within 10 to 14 days of the injury; otherwise, an open debridement may be necessary to address scar tissue formation. Description We start with the patient in the supine position and perform a fluoroscopic stress examination of the joint. Next, the Lisfranc joint undergoes closed reduction, which is held in place with a clamp. Following reduction, a guidewire is drilled from the lateral border of the base of the 2nd metatarsal medially through the medial cuneiform, followed by a medial-to-lateral cannulated drill. The suspensory fixation is then passed lateral-to-medial, placing the suture button on the lateral cortex of the 2nd metatarsal base. The tape is then tensioned while a bioabsorbable interference screw is inserted to maintain tension. Alternatives Prior studies have assessed both operative and nonoperative alternatives to CRPF with suspensory fixation for the treatment of Lisfranc injuries. Nonoperative treatment with closed reduction and cast immobilization of Lisfranc injuries is typically reserved for nondisplaced injuries; however, a number of studies have shown poor outcomes with use of this technique1-3. The 2 most common operative alternatives are ORIF and primary arthrodesis4. Rationale CRPF with suspensory fixation offers several benefits over both traditional surgical techniques such as ORIF and primary arthrodesis, as well as over percutaneous reduction and internal fixation (PRIF) with a screw. Compared with ORIF and primary arthrodesis, a number of studies have shown that percutaneous treatment of Lisfranc injuries minimizes soft-tissue trauma and reduces the risk of postoperative complications such as wound breakdown, infection, and complex regional pain syndrome, while allowing for earlier participation in rehabilitation5-10. A systematic review of outcomes following PRIF with screw fixation also showed that percutaneous treatment of Lisfranc injuries is a safe and effective technique with good functional outcomes11. When comparing PRIF with a screw to our technique of CRPF with suspensory fixation, CRPF has the added benefit of creating a nonrigid fixation in the Lisfranc joint, which allows for increased range of motion of the medial column and improved return to activity12,13. The rigid fixation in PRIF with a screw can also lead to metal irritation, intra-articular screw fracture, and impaired mobility, which often necessitate the need for screw removal13-15. This fixation-related drawback is not present with our technique, and also avoids the need for use of a biologic substitute such as tendon grafts13. Expected Outcomes Following CRPF with suspensory fixation, patients can expect to return to full activity at 12 to 16 weeks postoperatively. Postoperatively, patients are typically kept non-weight-bearing for 6 weeks. The operative foot is kept immobilized in a splint for the first 2 weeks, then transitioned to a boot. Between postoperative weeks 6 and 12, partial progressive weight-bearing is introduced with use of an arch support, progressing toward full weight-bearing13,16,17.For comparison, patients who underwent PRIF with screw fixation had a similar postoperative course, but almost all required screw removal at 4 to 6 months postoperatively13,16. Cho et al. retrospectively reviewed the results of 63 patients who underwent either PRIF with screw fixation (n = 32) or CRPF with a suture button (n = 31) and found that CRPF patients had significantly better American Orthopaedic Foot & Ankle Society midfoot scale scores (81 versus 74 points) and visual analog scale scores (3.1 versus 4.6 points) at 6 months postoperatively and prior to screw removal in the PRIF group (p < 0.001). There were no significant differences in these scores, radiographic outcomes, weight-bearing analysis, or complications at 1 year postoperatively. The authors concluded that both techniques provided comparable fixation stability and clinical outcomes. Of note, however, the PRIF group had 4 patients whose postoperative course was complicated by screw breakage13. Important Tips Start with a fluoroscopic stress examination to identify all components of instability.Ensure that the reduction clamp does not interfere with or affect your guidewire path.If the joint cannot be reduced, convert to an open procedure and debride the obstruction. Acronyms and Abbreviations ORIF = open reduction and internal fixationPRIF = percutaneous reduction and internal fixationCRPF = closed reduction and percutaneous fixationNSAID = nonsteroidal anti-inflammatory drugOR = operating roomAP = anteroposteriorCT = computed tomographyMRI = magnetic resonance imagingAOFAS = American Orthopaedic Foot & Ankle SocietyVAS = visual analog scaleROM = range of motionPT = physical therapyASA = acetyl-salicylic acid (aspirin)BID = twice dailyPRN = as needed.
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Affiliation(s)
- Miraj N. Desai
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Kevin D. Martin
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Rhodes AML, McMenemy L, Connell R, Elliot R, Marsland D. A Systematic Review of Outcomes Following Lisfranc Injury Fixation: Removal vs Retention of Metalwork. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221125447. [PMID: 36247414 PMCID: PMC9558891 DOI: 10.1177/24730114221125447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Following Lisfranc injury fixation, no consensus exists on whether to
routinely remove metalwork. The aim of this study was to evaluate functional
outcomes and complications in patients following routine removal of
metalwork and in those with retained metalwork. Methods: A systematic review of literature (1999-2020) reporting results of metalwork
removal vs retention following Lisfranc injury fixation, was undertaken. The
primary outcome was functional outcomes at 1 year following index surgery.
Secondary outcomes were rates of complications including unplanned removal
of metalwork. Results: No studies directly comparing routine metalwork removal vs retention were
found. A total of 28 studies reporting on 1069 patients were included. Of
these, 10 studies (317 patients) reported on retention and 18 (752 patients)
on routine removal of metalwork. The difference in the American Orthopaedic
Foot & Ankle Society (AOFAS) score between removal and retention groups
was 3.38 (95% CI 6.3-0.48), P = .02 (removal 79.97 [±16.09;
71-96]; retention 76.59 [±20.36; 65.4-94]). No difference in reported rates
of infection was found between the 2 groups (0%-12% for both groups). Of the
317 patients in the retention group, metalwork was removed in 198 cases,
resulting in a 62.5% unplanned removal rate. Conclusion: In conclusion, this systematic review found limited evidence comparing
different strategies of metalwork management after Lisfranc injury fixation.
A randomized controlled trial is necessary to elucidate if routine removal
of metalwork confers any true benefit. Level of Evidence: Level IV, systematic review including case series.
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Affiliation(s)
- Amanda M. L. Rhodes
- Hampshire Hospitals NHS Foundation
Trust, United Kingdom,Amanda M. L. Rhodes, BSc,
FRCS(Tr&Orth), Hampshire Hospitals NHS Foundation Trust, Aldermaston Road,
Basingstoke, England, RG24 9NA, United Kingdom.
| | | | | | - Robin Elliot
- Hampshire Hospitals NHS Foundation
Trust, United Kingdom
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6
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Sullivan M, Peckston D, Alpuerto B. Shortening the Return-to-Play Times in Elite Athletes With Unstable Isolated Lisfranc Ligament Injuries Using a Knotless Interosseous Suture Button: Case Series and Literature Review. Orthop J Sports Med 2022; 10:23259671221102969. [PMID: 35757241 PMCID: PMC9218474 DOI: 10.1177/23259671221102969] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Isolated unstable Lisfranc ligament injuries in elite athletes are associated with a lengthy period of rehabilitation and prolonged absence from competition. Purpose: To assess the efficacy of a knotless, interosseous suture button system for repairing isolated unstable ligamentous Lisfranc injuries and its capacity to allow accelerated rehabilitation with earlier weightbearing and return-to-play times in elite athletes. Study Design: Case series; Level of evidence, 4. Methods: The authors retrospectively reviewed data from a prospectively compiled database for elite athletes treated by a single surgeon. All included patients had clinical and magnetic resonance imaging evidence of an unstable isolated complete ligamentous Lisfranc injury requiring surgical reduction and stabilization. All patients underwent surgery using a knotless interosseous suture button to achieve stabilization, followed by a standardized postoperative regimen involving full weightbearing at 4 weeks, and all had a minimum postoperative follow-up of 2 years. Results: Included were 12 patients: 7 National Rugby League (NRL) players, 2 professional dancers, 1 Olympic gymnast, 1 professional wakeboarder, and 1 professional NRL referee. The mean age of the patients was 21.1 years (range, 16-34 years). Ten patients underwent acute surgical stabilization within 3 weeks of the injury, and 2 patients sustained chronic isolated Lisfranc instability that was initially treated nonoperatively. All athletes were able to return to full weightbearing by 4 weeks postoperatively, successfully returned to training by 9 to 12 weeks, and returned to full competition by 12 to 16 weeks. No major complications were reported. Conclusion: Knotless interosseous suture button stabilization was a reliable treatment option for both acute and chronic isolated ligamentous Lisfranc injuries in these elite athletes. This technique does not require hardware removal, allows early weightbearing with accelerated rehabilitation, and may shorten the return-to-play interval.
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Affiliation(s)
- Martin Sullivan
- St. Vincent’s Clinic, Sydney, Australia
- Martin Sullivan, FRACS, FAOrth, St. Vincent’s Clinic, 438 Victoria St, Darlinghurst, NSW 2010, Australia ()
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7
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Walley KC, Semaan DJ, Shah R, Robbins C, Walton DM, Holmes JR, Talusan PG. Long-term Follow-up of Lisfranc Injuries Treated With Open Reduction Internal Fixation Patient-Reported Outcomes. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211039496. [PMID: 35097469 PMCID: PMC8702685 DOI: 10.1177/24730114211039496] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: There remains a paucity of data regarding long-term patient-reported outcomes following Lisfranc injuries. We sought to collect long-term clinical outcome data following Lisfranc injuries using PROMIS Physical Function (PROMIS-PF) and visual analog scale–foot and ankle (VAS-FA). Methods: A chart review was performed to identify all patients who had surgical treatment of an acute Lisfranc injury at our institution from 2005 to 2014. Of the 45 patients identified, we were able to recruit 19 for a follow-up clinic visit consisting of physical examination, administration of questionnaires addressing pain and medication usage, radiographs, and completion of outcome surveys including PROMIS-Physical Function and visual analog scale–foot and ankle. Results: There were 14 female and 5 male patients enrolled in the study with a mean time of 6.25 years from the time of injury. Within this cohort, the mean PROMIS-PF score was 52.4±8.2 and the mean VAS–foot and ankle score was 76.6±22.3. Conclusion: We report satisfactory long-term patient-reported outcomes using PROMIS-PF and VAS-FA. Level of Evidence: Level III, retrospective cohort study.
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Affiliation(s)
- Kempland C Walley
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Derek J Semaan
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ronit Shah
- College of Medicine, University of Toledo, Toledo, OH, USA
| | - Christopher Robbins
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - David M Walton
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - James R Holmes
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Paul G Talusan
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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8
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Philpott A, Epstein DJ, Lau SC, Mnatzaganian G, Pang J. Lisfranc Fixation Techniques and Postoperative Functional Outcomes: A Systematic Review. J Foot Ankle Surg 2021; 60:102-108. [PMID: 33039319 DOI: 10.1053/j.jfas.2020.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/10/2019] [Accepted: 04/07/2020] [Indexed: 02/03/2023]
Abstract
The optimal method of fixation of acute Lisfranc injuries is yet to be established. We aim to systematically review the literature to identify the impact of fixation method on postoperative functional outcomes. A systematic review was undertaken using the PRISMA framework to identify all studies reporting postoperative functional outcomes in patients who underwent open-reduction internal fixation of acute Lisfranc injuries. Studies reporting outcomes of numerous fixation methods were divided into fixation subcohorts. Studies comparing bridge plate with transarticular screw fixation were included for meta-analysis, conducted using a random-effects model. Seventeen studies (20 subcohorts) with 462 patients were included. Mean patient age was 29.6 (rang, 15-81) years. Mean follow-up was 38.7 (range 11 to 287) months. American Academy of Orthopaedic Surgeons midfoot score (AOFAS-MF) was the most frequently reported functional outcome (16/20 subcohorts). Overall weighted mean AOFAS-MF was 76.3 ± 9.4 for all cases, with 74.2 ± 9.4 for transarticular screws and 79.2 ± 8.3 for bridge plates. The mean difference between screw and plate was not statistically significant (mean difference = 5.0, 95% confidence interval, -4.8 - 14.8, p = .3). A single study reported AOFAS-MF mean of 92 using suture button fixation. Meta-analysis of the 2 available comparative studies revealed higher postoperative AOFAS-MF with bridge plate fixation (pooled standardized mean difference, 0.51; 95% confidence interval, 0.15-0.87, p = .006). There is scarcity of literature examining the impact of fixation method on postoperative functional outcomes in acute Lisfranc injuries. A small number of studies have reported superior functional outcomes with use of bridge plate fixation. Further evidence is needed to ascertain which injuries are best managed with each fixation method or whether 1 fixation construct is universally superior.
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Affiliation(s)
- Andrew Philpott
- Orthopaedic Registrar, Bendigo Base Hospital, Bendigo, Victoria, Australia.
| | - Daniel J Epstein
- Orthopaedic Registrar, Bendigo Base Hospital, Bendigo, Victoria, Australia
| | - Simon C Lau
- Orthopaedic Registrar, Royal Melbourne Hospital, Victoria, Australia
| | - George Mnatzaganian
- Statistician, La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Victoria, Australia
| | - Jack Pang
- Consultant Orthopaedic Surgeon, Bendigo Base Hospital, Bendigo, Victoria, Australia
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Park YH, Ahn JH, Choi GW, Kim HJ. Percutaneous Reduction and 2.7-mm Cortical Screw Fixation for Low-Energy Lisfranc Injuries. J Foot Ankle Surg 2021; 59:914-918. [PMID: 32345510 DOI: 10.1053/j.jfas.2019.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/24/2019] [Accepted: 10/03/2019] [Indexed: 02/03/2023]
Abstract
To use the advantages of transarticular screw fixation while minimizing iatrogenic involved joint damage and screw irritation, it is important to determine the screw size. The aim of this study was to analyze the outcomes of percutaneous reduction and 2.7-mm cortical screw fixation for low-energy Lisfranc injuries and determine whether the procedure is a safe alternative to traditional screw fixation using a larger screw size. A review was performed for all patients who underwent percutaneous reduction and 2.7-mm cortical screw fixation for low-energy Lisfranc injuries at a single institution over a 6-year period. Thirty-one patients were enrolled in this study. Patients were assessed clinically and radiographically for demographics, foot function index (FFI), numerical rating scale (NRS) for pain, patient satisfaction, and complication rates. Factors affecting screw breakage and its clinical relevance were also analyzed. The FFI and NRS for pain were 17.2 ± 14.7 (range 0.8 to 57.8) and 3.1 ± 2.3 (range 0 to 8) points, respectively, at the 12-month follow-up visit. One patient (3.2%) underwent arthrodesis for the development of posttraumatic arthritis; all other patients recovered without sequelae. Screw breakage was identified in 7 patients (22.6%). There was no significant difference between patients with and without screw breakage in terms of FFI, NRS for pain, patient satisfaction, or complication rate. Body mass index (BMI) was significantly higher in patients with screw breakage than in those without screw breakage. Receiver operator characteristics curve analysis demonstrated a strong relationship between BMI and screw breakage (area under the curve = 90%, p < .001), and the potential BMI cutoff value was 27.8 kg/m2. After considering the incidence of screw breakage, percutaneous reduction and 2.7-mm cortical screw fixation can be a viable option for treating low-energy Lisfranc injuries in nonobese patients, especially those with BMI <27.8 kg/m2.
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Affiliation(s)
- Young Hwan Park
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jeong Hwan Ahn
- Orthopaedic Resident, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Gi Won Choi
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Hak Jun Kim
- Professor and Orthopaedic Surgeon, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea.
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10
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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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Sports-Related Lisfranc Injuries and Recognition of Lisfranc Variants: Surgical Strategies for Stabilization. Foot Ankle Clin 2021; 26:13-33. [PMID: 33487236 DOI: 10.1016/j.fcl.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
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.
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Yan A, Chen SR, Ma X, Shi Z, Hogan M. Updates on Lisfranc Complex Injuries. FOOT & ANKLE ORTHOPAEDICS 2021; 6:2473011420982275. [PMID: 35097425 PMCID: PMC8702936 DOI: 10.1177/2473011420982275] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Lisfranc injuries are a disruption of one or more of the tarsometatarsal joints and have an estimated incidence of 1/55 000 people. However, the total number of Lisfranc injuries could be underreported, because almost 20% of these injuries are initially missed. Because of the relative infrequency of these injuries, the current literature is inconsistent in regard to proper treatment. This article provides a review of Lisfranc complex injuries including relevant anatomy, diagnosis, treatment, classifications, operative approaches, and outcomes and complications. Based on existing evidence, it also proposes an algorithm the authors prefer for the evaluation and treatment of Lisfranc complex injuries.
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Affiliation(s)
- Alan Yan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- The Foot and Ankle Injury Research (FAIR) Group, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen R. Chen
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- The Foot and Ankle Injury Research (FAIR) Group, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhongmin Shi
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - MaCalus Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- The Foot and Ankle Injury Research (FAIR) Group, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
The management of Lisfranc injuries is challenging considering the broad spectrum of energy involved and highly variable clinical presentation. Despite the advances in surgical techniques, subtle Lisfranc injuries can lead to chronic pain and permanent disability. Surgical treatment is mandatory for all the unstable injuries; however, the best surgical technique remains controversial. The most predictive factor for a successful outcome is the maintenance of anatomic alignment; therefore, the selection of the appropriate surgical technique is of paramount importance. This article reviews the current treatment options and describes the selection of the surgical technique based on the different clinical presentations.
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Affiliation(s)
- Jorge Briceno
- Department of Orthopedic Surgery, Pontificia Universidad Catolica de Chile. Diagonal Paraguay 362, Postal code: 8330077, Santiago, Región Metropolitana, Chile
| | - Anna-Kathrin Leucht
- Department of Orthopaedics and Traumatology, Cantonal Hospital of Winterthur, Buchnerstrasse 1, 8006 Zurich, Switzerland
| | - Alastair Younger
- Department of Orthopaedics, Division of Distal Extremities, University of British Columbia, Vancouver, British Columbia, Canada; Department of Orthopedics, St. Paul's Hospital, UBC, Vancouver, Canada; Footbridge Centre for Integrated Orthopaedic Care Inc., Footbridge Clinic, 221-181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, Division of Distal Extremities, University of British Columbia, Vancouver, British Columbia, Canada; Department of Orthopedics, St. Paul's Hospital, UBC, Vancouver, Canada; Footbridge Centre for Integrated Orthopaedic Care Inc., Footbridge Clinic, 221-181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada.
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Abarquero-Diezhandino A, Ferrero-Recasens J, Vacas-Sanchez E, Mellado-Romero M, Sánchez-Morata E, Vila-Rico J. Study of the functional results of the percutaneous surgical treatment of subtle injuries of the tarso-metatarsian complex. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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15
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Abarquero-Diezhandino A, Ferrero-Recasens J, Vacas-Sánchez E, Mellado-Romero MA, Sánchez-Morata EJ, Vilá-Rico J. Study of the functional results of the percutaneous surgical treatment of subtle injuries of the tarso-metatarsian complex. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:367-374. [PMID: 32798164 DOI: 10.1016/j.recot.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The concept subtle Lisfranc defines low energy lesions of the tarsometatarsal joint complex (TMC) that involve joint instability. Often unnoticed, with long-term sequelae. The objective is to evaluate the clinical-functional results of patients with MTC ligament damage grade II-III (Nunley and Vertullo classification) treated with percutaneous surgery. MATERIAL AND METHODS Retrospective study of 16 patients who underwent percutaneous surgery for MLC ligament damage. Demographic data, days of delay in diagnosis, surgical technique, joint reduction in load (adequate if C1-M2 space is less than 2 mm) and Manchester-Oxford scale (MOXFQ) score were collected. The sample consisted of nine males and seven females, mean age 43.6 years (17-71) and mean follow-up of 22 months (12-28). RESULTS Diagnosis was delayed for more than 24 hours in four patients (3-6 days). In 11 patients the treatment consisted of closed reduction and percutaneous synthesis with cannulated screws from M2 to C1 and from C1 to C2. In three patients it was supplemented with Kirschner wires in the lateral radii. Two patients were treated with only M2 to C1 screws. An anatomical reduction was not achieved in six patients, with a mean of 2.6 mm between C1-M2 (2.1-3 mm); the mean functional MOXFQ score of these patients was 41.1% (IC 95% 23.1-59.1%), worse results compared to the anatomical reduction: 17.2% (IC 95% 5.7-28.7); statistically significant difference (p < 0.01). CONCLUSION Subtle injuries from MTC are rare and can go unnoticed. Surgical treatment with percutaneous synthesis offers good clinical-functional results in the medium term. The anatomical reduction is a determining factor for the good functional result of our patients.
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Affiliation(s)
| | | | - E Vacas-Sánchez
- Hospital Universitario 12 de Octubre, Madrid, España; Complejo Hospitalario Ruber Juan Bravo. Grupo Quirón Salud, Madrid, España
| | | | | | - J Vilá-Rico
- Hospital Universitario 12 de Octubre, Madrid, España; Universidad Complutense de Madrid, Madrid, España; Complejo Hospitalario Ruber Juan Bravo. Grupo Quirón Salud, Madrid, España
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Lisfranc fleck sign: characteristics and clinical outcomes following fixation using a percutaneous position Lisfranc screw. Eur J Trauma Emerg Surg 2020; 48:471-479. [PMID: 32561962 DOI: 10.1007/s00068-020-01415-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/06/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Avulsion of the Lisfranc ligament, fleck sign, results in unstable Lisfranc injuries. This cross-sectional study was conducted to investigate the characteristics of Lisfranc injuries with fleck sign and the clinical and radiological outcomes following closed reduction and percutaneous screw fixation. METHODS All consecutive operatively managed Lisfranc injuries with fleck sign were reviewed from 2016 to 2018. The injury pattern and characteristics of Lisfranc fleck sign were reviewed based on the preoperative CT scan. Postoperative complications besides radiological and clinical outcomes were assessed using visual analog scale (VAS) pain, American orthopedic foot and ankle society (AOFAS) midfoot scale, and foot function index (FFI). RESULTS Thirty patients (20 males; mean age, 36.9 ± 17.0; range, 12-69 years) with mean follow-up 16.9 ± 7.4 (range, 6-31) months were enrolled. Among 12 cases with avulsed Lisfranc ligament from the second metatarsal base, only two cases had isolated second metatarsal base fracture in plantar medial part while others had concomitant avulsion fracture of plantar aspect of the adjacent third and/or fourth metatarsal base. Mean of postoperative VAS pain, AOFAS midfoot scale, and FFI were 1.03 ± 0.29, 91.43 ± 1.43, 24.43 ± 6.66, respectively. We had seven (23.3%) removal of screws, two (6.6%) broken screws, four (13.3%) pulled-out screws, and six (20%) lost reductions in the final follow-up with good clinical functions. CONCLUSION Closed reduction and percutaneous fixation of the Lisfranc injuries with fleck sign by a single position screw could be a good surgical option with reliable and predictable outcomes without needing to remove the hardware, routinely.
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Sharma S, Dhillon MS, Arora C, Patel S. Percutaneous fixation of Lisfranc injuries. J Clin Orthop Trauma 2020; 11:487-491. [PMID: 32405216 PMCID: PMC7211822 DOI: 10.1016/j.jcot.2020.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/25/2022] Open
Abstract
Lisfranc injuries may occur in the form of fracture-dislocations or pure ligamentous dislocations or subluxations. These innocuous appearing injuries have the potential for significant morbidity and long-term sequelae resulting in permanent deformities. Ligamentous subluxations account for 20% of these injuries and cases with partial incongruity are amenable to percutaneous fixation. In this article, we present step-by-step percutaneous fixation of these injuries as well as the post-operative management.
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Stavrakakis IM, Magarakis GE, Christoforakis Z. Percutaneous fixation of Lisfranc joint injuries: A systematic review of the literature. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:457-462. [PMID: 31575479 PMCID: PMC6939019 DOI: 10.1016/j.aott.2019.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/27/2019] [Accepted: 08/22/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this systematic review was to present the outcome of Lisfranc joint injuries treated with closed reduction and screw percutaneous fixation. METHODS We searched in Pubmed and Google Scholar Databases for articles regarding screw percutaneous fixation of Lisfranc injuries. Seven studies in total were found to be compatible to our search, according to PRISMA guidelines. Four of those met the criteria of the review and they were included in the meta-analysis. A total number of 106 patients were separated into five groups according to the type of injury and the mean AOFAS score of each group was calculated. Cases in which percutaneous fixation was converted to open treatment due to poor reduction were not included in the study. In addition we compared the outcome score between types of injury according to Myerson classification as well as between purely ligamentous and osseoligamentous injuries. The characteristics of all seven selected studies, such as kind of screw used for fixation, post operative protocol, complications and outcome are mentioned as well. RESULTS Average AOFAS score was 86,2 for type A, 87,54 for type B, and 85 for type C injuries respectively. In pure dislocation group the average AOFAS score was 86,43 and in fracture dislocation group was 87,36. Good to excellent outcome can be expected in patients with different types of injury according to Myerson classification following percutaneous fixation of lisfranc joint injury. Patients with type B injury or a fracture dislocation injury might have better outcome, although this difference was not found to be statistically significant. CONCLUSION Percutaneous fixation of tarsometatarsal joint injuries is a relatively simple and safe method of treatment, leading to a good functional outcome, especially for Myerson type B as well as for fracture dislocation type of injuries, provided that an anatomical reduction has been achieved. LEVEL OF EVIDENCE Level III, Therapeutic Study.
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Affiliation(s)
| | - George E Magarakis
- Department of Orthopaedics, Venizeleio General Hospital of Heraklion, Greece
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Wu S, Qin B, Xie H, Huang F, Zhang H. [Effectiveness of open reduction and internal fixation for acute and delayed occult Lisfranc injuries]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:965-969. [PMID: 31407554 DOI: 10.7507/1002-1892.201901004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To evaluate the effectiveness of open reduction and internal fixation (ORIF) in treatment of acute and delayed occult Lisfranc injuries. Methods A retrospective review of 26 patients with occult Lisfranc injuries who were treated with ORIF between July 2010 and July 2015 was applied. Fourteen patients were treated within 6 weeks after injury (acute group) and 12 patients were treated after 6 weeks of injury (delayed group). There was no significant difference between the two groups in gender, age, affected sides, and preoperative visual analogue scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) score, and physical and mental scores of Study Short Form 12 Health Survey (SF-12) ( P<0.05). The joint reduction, internal fixator, and traumatic osteoarthritis were observed by X-ray films. The pain degree, midfoot function, and quality of life were evaluated with VAS score, AOFAS score, and physical and mental scores of SF-12. Results All incisions healed by first intention with no complications. All patients were followed up with the mean follow-up time of 15 months (range, 12-24 months) in acute group and 15 months (range, 12-23 months) in delayed group. At last follow-up, the VAS score, AOFAS score, and physical and mental scores of SF-12 were superior to those before operation in the two groups ( P<0.05). And there was no significant difference in all indicators between the two groups ( P>0.05). The satisfaction rates were 100% and 83.3% (10/12) in acute group and delayed group, respectively. The internal fixators were removed in 20 patients (11 cases in acute group and 9 cases in delayed group) at 9-24 months after operation (mean, 14.5 months). The results of X-ray films showed no traumatic osteoarthritis, midfoot collapse, internal fixation failure, or reduction loss during follow-up period. Conclusion ORIF is an ideal method for both acute and delayed occult Lisfranc injuries and can obtain the similar effectiveness.
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Affiliation(s)
- Shizhou Wu
- West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Boquan Qin
- West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Huiqi Xie
- Laboratory of Stem Cell and Tissue Engineering, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hui Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Ren W, Li HB, Lu JK, Hu YC. Undisplaced subtle ligamentous Lisfranc injuries, conservative or surgical treatment with percutaneous position screws? Chin J Traumatol 2019; 22:196-201. [PMID: 31235287 PMCID: PMC6667927 DOI: 10.1016/j.cjtee.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/20/2019] [Accepted: 05/15/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Undisplaced subtle ligamentous Lisfranc injuries are easy to miss or underestimate, and many cases are treated without surgical fixation. It has not yet widely known whether conservative treatment for undisplaced subtle ligamentous Lisfranc injuries may lead to a poor outcome. The purpose of this study is to compare the outcomes of conservative versus surgical management (percutaneous position screw) of undisplaced subtle ligamentous Lisfranc injury. METHODS We analysed 61 cases in this retrospective study, including 38 males and 23 females. Forty-one patients were managed conservatively, while 20 patients received surgical treatment involving minimal invasive percutaneous position screw. American orthopaedic foot &ankle society (AOFAS), foot function index (FFI, including FFI disability, FFI pain score and activity limitation scale) scores, Maryland foot score and short form-36 (SF-36) were recorded and compared after a follow-up of 10-16 months (average 12.3). RESULTS Patients in the surgical management group had higher scores in all evaluation methods (p < 0.05). The complications in the conservative management group had higher incidence, mainly including secondary diastasis (34.1% vs. 5.0%), joint stiffness after 3 months (82.9% vs. 0%), and secondary arthrodesis (12.2% vs. 0%). The highest rate of complication in surgical management group was temporary forefoot pain (55.0%). CONCLUSION The results of this study suggest that the outcomes of the surgical management with percutaneous position screw fixation are better than the conservative management to treat undisplaced subtle ligamentous Lisfranc injuries. This study can serve as a resource for orthopaedic surgeons in recognizing and managing such injuries.
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Affiliation(s)
- Wei Ren
- Tianjin Medical University, Tianjin 300070, China,Department of Orthopedic Surgery, United Family Hospital, Beijing 100015, China
| | - Hai-Bo Li
- Department of Orthopedic, Tianjin Hospital, Tianjin 300211, China
| | - Ji-Ke Lu
- Department of Orthopedic Surgery, United Family Hospital, Beijing 100015, China
| | - Yong-Cheng Hu
- Tianjin Medical University, Tianjin 300070, China,Department of Orthopedic, Tianjin Hospital, Tianjin 300211, China,Corresponding author. Tianjin Medical University, No. 22, Qi Xiangtai Road, Heping District, 300070, Tianjin, China.
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Abstract
It is essential to know and understand the anatomy of the tarsometatarsal (TMT) joint (Lisfranc joint) to achieve a correct diagnosis and proper treatment of the injuries that occur at that level. Up to 20% of Lisfranc fracture-dislocations go unnoticed or are diagnosed late, especially low-energy injuries or purely ligamentous injuries. Severe sequelae such as post-traumatic osteoarthritis and foot deformities can create serious disability. We must be attentive to the clinical and radiological signs of an injury to the Lisfranc joint and expand the study with weight-bearing radiographs or computed tomography (CT) scans. Only in stable lesions and in those without displacement is conservative treatment indicated, along with immobilisation and initial avoidance of weight-bearing. Through surgical treatment we seek to achieve two objectives: optimal anatomical reduction, a factor that directly influences the results; and the stability of the first, second and third cuneiform-metatarsal joints. There are three main controversies regarding the surgical treatment of Lisfranc injuries: osteosynthesis versus primary arthrodesis; transarticular screws versus dorsal plates; and the most appropriate surgical approach. The surgical treatment we prefer is open reduction and internal fixation (ORIF) with transarticular screws or with dorsal plates in cases of comminution of metatarsals or cuneiform bones.
Cite this article: EFORT Open Rev 2019;4:430-444. DOI: 10.1302/2058-5241.4.180076
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Escudero MI, Symes M, Veljkovic A, Younger ASE. Low-Energy Lisfranc Injuries in an Athletic Population: A Comprehensive Review of the Literature and the Role of Minimally Invasive Techniques in Their Management. Foot Ankle Clin 2018; 23:679-692. [PMID: 30414660 DOI: 10.1016/j.fcl.2018.07.014] [Citation(s) in RCA: 6] [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: 02/02/2023]
Abstract
Tarsometatarsal (TMT) joint complex injuries can be caused by either direct or indirect injuries. The Lisfranc joint represents approximately 0.2% of all fractures. Up to 20% of these injuries are misdiagnosed or missed on initial radiographic assessment; therefore, a high index of suspicion is needed to accurately diagnose TMT joint injuries and avoid the late sequelae of substantial midfoot arthrosis, pain, decreased function, and loss of quality of life. This review discusses the anatomy, diagnosis, and management of athletic Lisfranc injuries, including a description of the preferred minimally invasive surgical techniques used by the senior author of this article.
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Affiliation(s)
- Mario I Escudero
- Department of Orthopaedics, Division of Distal Extremities, University of British Columbia, Suite 221, 181 Keefer Street, Vancouver, BC V6B 6C1, Canada
| | - Michael Symes
- Department of Orthopaedics, Division of Distal Extremities, University of British Columbia, Suite 221, 181 Keefer Street, Vancouver, BC V6B 6C1, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, Division of Distal Extremities, University of British Columbia, Suite 221, 181 Keefer Street, Vancouver, BC V6B 6C1, Canada
| | - Alastair S E Younger
- Department of Orthopaedics, Division of Distal Extremities, University of British Columbia, Suite 221, 181 Keefer Street, Vancouver, BC V6B 6C1, Canada.
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Mora AD, Kao M, Alfred T, Shein G, Ling J, Lunz D. Return to Sports and Physical Activities After Open Reduction and Internal Fixation of Lisfranc Injuries in Recreational Athletes. Foot Ankle Int 2018; 39:801-807. [PMID: 29606024 DOI: 10.1177/1071100718765176] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to assess participation in sport and physical activity following open reduction and internal fixation of a Lisfranc injury in a cohort of recreational athletes. METHODS This study identified all adult patients aged 55 years or younger who presented with a Lisfranc injury and underwent open reduction and internal fixation (ORIF) using a Lisfranc screw combined with bridge plating technique. Sports and 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). Thirty-three patients qualified for the study (21 men/12 women). Mean age and follow-up were 31.2 (range, 18-55) years and 2.9 (range, 1.5-5.4) years, respectively. RESULTS Postoperatively, 31 patients (94%) were able to return to some form of sport. Twenty-two patients (66%) returned to playing sport at or above their preinjury level. Of the 11 patients who played less sport, 6 had ongoing pain, and the remaining 5 were asymptomatic but were participating less frequently because of other lifestyle reasons. In addition, of the 33 patients, 11 (33%) had some degree of ongoing pain that might limit their ability to return to sports and physical activities. There was strong correlation between overall FAOS and the Sports Questionnaire. CONCLUSION Most patients who sustained a Lisfranc injury could return to sport and physical activity after ORIF. Patients should be counseled preoperatively that about 1 in 3 might experience continued pain at the injury site Level of Evidence: Level IV, retrospective case series.
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Affiliation(s)
| | - Mark Kao
- 1 Prince of Wales Hospital, Sydney, NSW, Australia
| | | | | | - Jeff Ling
- 1 Prince of Wales Hospital, Sydney, NSW, Australia
| | - David Lunz
- 1 Prince of Wales Hospital, Sydney, NSW, Australia
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