1
|
Ponkilainen V, Mäenpää H, Laine HJ, Partio N, Väistö O, Jousmäki J, Mattila VM, Haapasalo H. Open Reduction Internal Fixation vs Primary Arthrodesis for Displaced Lisfranc Injuries: A Multicenter Randomized Controlled Trial. Foot Ankle Int 2024; 45:612-620. [PMID: 38482816 DOI: 10.1177/10711007241232667] [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] [Indexed: 06/11/2024]
Abstract
BACKGROUND There is no consensus whether the primary surgical method should be open reduction and internal fixation (ORIF) or primary arthrodesis (PA) for Lisfranc injuries. The aim of our randomized controlled trial was to compare ORIF and PA for displaced Lisfranc injuries. METHODS This study was a national multicenter randomized controlled trial. Altogether 43 displaced Lisfranc injuries were enrolled in this trial. The primary outcome measure was Visual Analogue Scale Foot and Ankle (VAS-FA) at a 24-months follow-up. The secondary outcome measures were VAS-FA pain, function, and other complaints subscales and the American Orthopaedic Foot & Ankle Society (AOFAS) Midfoot Scale. All outcomes were measured at 6, 12, and 24 months. We were unable to reach the planned sample size of 60 patients; thus, the study remains underpowered. RESULTS The mean VAS-FA Overall score in the ORIF group was 86.5 (95% CI 77.9, 95.1) and 80.1 (95% CI 72.0, 88.1) in the PA group at the 24-month follow-up. We did not find eligible evidence of a difference in VAS-FA Overall scores (mean between-group difference 6.5 [95% CI -5.3, 18.2], Cohen d = 0.100). CONCLUSION We did not find evidence of a difference in VAS-FA between ORIF and PA in patients with displaced Lisfranc injuries, and thus both are viable options for the initial surgical method. The trial is underpowered; however, the data may be included in a meta-analysis of similarly designed randomized controlled trials.ClinicalTrials.gov identifier: NCT02953067 24 October 2016.
Collapse
Affiliation(s)
- Ville Ponkilainen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Heikki Mäenpää
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | | | - Nikke Partio
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Olli Väistö
- Department of Orthopaedics and Traumatology, Seinäjoki Central Hospital, Seinäjoki, Finland
| | | | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland
- COXA Hospital for Joint Replacement, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | | |
Collapse
|
2
|
Cibura C, Lülsdorff R, Rosteius T, Brinkemper A, Bernstorff M, Jettkant B, Godolias P, Ramczykowski T, Königshausen M, Schildhauer TA, Kruppa C. Effects on gait kinematics, pedobarography, functional and subjective results after isolated chopart injury. BMC Musculoskelet Disord 2024; 25:335. [PMID: 38671405 PMCID: PMC11046766 DOI: 10.1186/s12891-024-07467-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND This study analysed changes in gait and pedobarography and subjective and functional outcomes after isolated Chopart joint injury. METHODS The results of 14 patients were reviewed. Kinematic 3D gait analysis, comparative bilateral electromyography (EMG) and pedobarography were performed. RESULTS On the injured side, the 3D gait analysis showed a significantly increased internal rotation and decreased external rotation of the hip and significantly decreased adduction and decreased range of motion (ROM) for the ankle. On the healthy side, the pedobarography revealed a significantly increased mean force in the forefoot, an increased peak maximum force and an increased maximum pressure in the metatarsal. When standing, significantly more weight was placed on the healthy side. The EMG measurements showed no significant differences between the healthy and injured legs. CONCLUSIONS After isolated Chopart injuries, significant changes in gait and pedobarography can be seen over the long term.
Collapse
Affiliation(s)
- Charlotte Cibura
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany, Bürkle-de-la-Camp Platz 1, 44789.
| | - Raimund Lülsdorff
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany, Bürkle-de-la-Camp Platz 1, 44789
| | - Thomas Rosteius
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany, Bürkle-de-la-Camp Platz 1, 44789
| | - Alexis Brinkemper
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany, Bürkle-de-la-Camp Platz 1, 44789
| | - Maria Bernstorff
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany, Bürkle-de-la-Camp Platz 1, 44789
| | - Birger Jettkant
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany, Bürkle-de-la-Camp Platz 1, 44789
| | - Periklis Godolias
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany, Bürkle-de-la-Camp Platz 1, 44789
| | - Tim Ramczykowski
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany, Bürkle-de-la-Camp Platz 1, 44789
| | - Matthias Königshausen
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany, Bürkle-de-la-Camp Platz 1, 44789
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany, Bürkle-de-la-Camp Platz 1, 44789
| | - Christiane Kruppa
- Department of General and Trauma Surgery, BG-University Hospital Bergmannsheil, Ruhr-University, Bochum, Germany, Bürkle-de-la-Camp Platz 1, 44789
| |
Collapse
|
3
|
Ahn BJ, Quinn M, Zhao L, He EW, Dworkin M, Naphade O, Byrne RA, Molino J, Blankenhorn B. Statistical Fragility Analysis of Open Reduction Internal Fixation vs Primary Arthrodesis to Treat Lisfranc Injuries: A Systematic Review. Foot Ankle Int 2024; 45:298-308. [PMID: 38327213 DOI: 10.1177/10711007231224797] [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: 02/09/2024]
Abstract
BACKGROUND There is a lack of consensus in the use of open reduction internal fixation (ORIF) vs primary arthrodesis (PA) in the management of Lisfranc injuries. Statistical fragility represents the number of events needed to flip statistical significance and provides context to interpret P values of outcomes from conflicting studies. The current study evaluates the statistical fragility of existing research with an outcome-specific approach to provide statistical clarity to the ORIF vs PA discussion. We hypothesized that statistical fragility analysis would offer clinically relevant insight when interpreting conflicting outcomes regarding ORIF vs PA management of Lisfranc injuries. METHODS All comparative studies, RCTs, and case-series investigating ORIF vs PA management of Lisfranc injuries published through October 5, 2023, were identified. Descriptive characteristics, dichotomous outcomes, and continuous outcomes were extracted. Fragility index and continuous fragility index were calculated by the number of event reversals needed to alter significance. Outcomes were categorized by clinical relevance, and median FI and CFI were reported. RESULTS A total of 244 studies were screened. Ten studies and 67 outcomes (44 dichotomous, 23 continuous) were included in the fragility analysis. Of the 10 studies, 4 studies claimed PA to correlate with superior outcomes compared to ORIF with regard to functional scores and return to function outcomes. Of these 4 studies, 3 were statistically robust. Six studies claimed PA and ORIF to have no differences in outcomes, in which only 2 studies were statistically robust. CONCLUSION The overall research regarding ORIF vs PA is relatively robust compared with other orthopaedic areas of controversy. Although the full statistical context of each article must be considered, studies supporting PA superiority with regard to functional scores and return to function metrics were found to be statistically robust. Outcome-specific analysis revealed moderate fragility in several clinically relevant outcomes such as functional score, return to function, and wound complications.
Collapse
Affiliation(s)
- Benjamin J Ahn
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Matthew Quinn
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Leon Zhao
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Elaine W He
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Myles Dworkin
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Om Naphade
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rory A Byrne
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Janine Molino
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brad Blankenhorn
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
4
|
Tang L, Zhou W, Bai L, Wu C, Xiong C, Yan Y, Chen S. Comparison of diagnostic performance of X‑ray, CT and MRI in patients with surgically confirmed subtle Lisfranc injuries. Exp Ther Med 2024; 27:174. [PMID: 38476900 PMCID: PMC10928826 DOI: 10.3892/etm.2024.12462] [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] [Received: 02/07/2023] [Accepted: 02/02/2024] [Indexed: 03/14/2024] Open
Abstract
The present study aimed to compare the diagnostic performance of three imaging tests: X-ray, computed tomography (CT) and magnetic resonance imaging (MRI), for subtle Lisfranc injuries and three anatomical subtype injuries. The non-weight-bearing X-ray, CT and MRI imaging results of patients with subtle Lisfranc injuries from September 2013 to March 2022 were retrospectively reviewed. Subtle Lisfranc injuries and three anatomical subtypes (first, second and cuneiform rays) were diagnosed based on the surgical reports. The diagnostic performance of X-ray, CT and MRI was compared. The sensitivity (Sn), specificity (Sp), positive predictive value, negative predictive value, area under the receiver operating characteristic curve (AUC) and κ coefficient were reported. A total of 31 patients were included in the study. The correct diagnosis was made in 48.4% (15/31), 87.1% (27/31) and 96.8% (30/31) of patients by X-ray, CT and MRI, respectively. A total of 54 different anatomical injuries were found intraoperatively in all patients, with MRI and CT having high agreement (Sn, 72.2 and 87.0%; κ, 0.69 and 0.78, respectively) and X-ray having a low agreement (Sn, 29.6%; κ, 0.26) with the surgical findings. Regarding the first-ray injuries, CT had the highest Sn (76.9%), Sp (100%) and AUC (0.885) in diagnosing subtle Lisfranc injuries. MRI showed the best Sn (88.5 and 93.3%, respectively) and AUC (0.942 and 0.904, respectively) in both second and cuneiform rays. In conclusion, non-weight-bearing X-rays had poor diagnostic accuracy for subtle Lisfranc injuries and their subtypes. CT was superior to X-rays and MRI in diagnosing first-ray injuries. Although not significantly different from CT in terms of overall diagnosis, MRI was superior to X-ray and CT in diagnosing second and cuneiform-ray injuries.
Collapse
Affiliation(s)
- Lubo Tang
- Department of Sports Medicine, Shenzhen Hospital of Peking University, Shenzhen, Guangdong 518036, P.R. China
| | - Wen Zhou
- Department of Medical Imaging, Shenzhen Hospital of Peking University, Shenzhen, Guangdong 518036, P.R. China
| | - Lu Bai
- Department of Sports Medicine, Shenzhen Hospital of Peking University, Shenzhen, Guangdong 518036, P.R. China
| | - Chenxi Wu
- Department of Sports Medicine, Shenzhen Hospital of Peking University, Shenzhen, Guangdong 518036, P.R. China
| | - Changyue Xiong
- Department of Sports Medicine, Shenzhen Hospital of Peking University, Shenzhen, Guangdong 518036, P.R. China
| | - Yuxin Yan
- Department of Sports Medicine, Shenzhen Hospital of Peking University, Shenzhen, Guangdong 518036, P.R. China
| | - Sumeng Chen
- Department of Sports Medicine, Shenzhen Hospital of Peking University, Shenzhen, Guangdong 518036, P.R. China
| |
Collapse
|
5
|
Metcalfe TSN, Aamir J, Mason LW. Chopart dislocations: a review of diagnosis, treatment and outcomes. Arch Orthop Trauma Surg 2024; 144:131-147. [PMID: 37715068 PMCID: PMC10774188 DOI: 10.1007/s00402-023-05040-4] [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: 01/20/2023] [Accepted: 08/14/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Chopart injuries can be allocated into 4 broad groups, ligamentous injury with or without dislocation and fracture with or without dislocation, which must occur at the talonavicular joint (TNJ) and/or calcaneocuboid joint (CCJ). Chopart dislocations are comprised of pure-dislocations and fracture-dislocations. We aim to review the literature, to enable evidence-based recommendations. METHODS A literature search was conducted to identify relevant articles from the electronic databases, PubMed, Medline and Scopus. The PRISMA flow chart was used to scrutinise the search results. Articles were screened by title, abstract and full text to confirm relevance. RESULTS We identified 58 papers for analysis, 36 case reports, 4 cohort studies, 4 case series and 14 other articles related to the epidemiology, diagnosis, treatment and outcomes of Chopart dislocations. Diagnostic recommendations included routine imaging to contain computed tomography (CT) and routine examination for compartment syndrome. Treatment recommendations included early anatomical reduction, with restoration and maintenance of column length and joint congruency. For both pure-dislocations and fracture-dislocations urgent open reduction and internal fixation (ORIF) provided the most favourable long-term outcomes. CONCLUSIONS Chopart dislocations are a complex heterogenous midfoot injury with historically poor outcomes. There is a relative paucity of research discussing these injuries. We have offered evidence-based recommendations related to the clinical and surgical management of these rare pathologies.
Collapse
Affiliation(s)
- Tobias S N Metcalfe
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK
- School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool, L69 3GE, UK
| | - Junaid Aamir
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK
| | - Lyndon W Mason
- Liverpool Orthopaedic and Trauma Service, Liverpool University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK.
- School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool, L69 3GE, UK.
| |
Collapse
|
6
|
van den Boom NAC, van den Hurk AA, Evers SMAA, Poeze M. Societal burden and quality of life in patients with Lisfranc Injuries. Injury 2023; 54:110913. [PMID: 37536004 DOI: 10.1016/j.injury.2023.110913] [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: 05/04/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The incidence of Lisfranc fractures is rising, along with the incidence of foot fractures in general. These injuries can lead to long-term healthcare use and societal costs. Current economic evaluation studies are scarce in Lisfranc fracture research, and only investigate the healthcare costs. The aim of the present study was to accurately measure the monetary societal burden of disease and quality of life in the first 6 months after the injury in patients with Lisfranc fractures in the Netherlands. MATERIALS AND METHODS This study used a prevalence-based, bottom-up approach. Patients were included through thirteen medical centres in the Netherlands. Both stable and unstable injuries were included. The societal perspective was used. The costs were measured at baseline, 12 weeks and 6 months using the iMTA MCQ and PCQ questionnaires. Reference prices were used for valuation. Quality-of-life was measured using the EQ-5D-5 L and VAS scores. RESULTS 214 patients were included. The mean age was 45.9 years, and 24.3% of patients had comorbidities. The baseline questionnaires yielded approximately €2023 as the total societal costs in the 3 months prior to injury. The follow-up questionnaires and surgery costs assessment yielded approximately €17,083 as the total costs in the first 6 months after injury. Of these costs, approximately two thirds could be attributed to productivity losses. The EQ-5D-5 L found a mean index value of 0.449 at baseline and an index value of 0.737 at the 6-month follow-up. CONCLUSION The total monetary societal costs in the first 6 months after injury are approximately €17,083. Approximately two thirds of these costs can be attributed to productivity losses. These costs appear to be somewhat higher than those found in other studies. However, these studies only included the healthcare costs. Furthermore, the baseline costs indicate relatively low healthcare usage before the injury compared to the average Dutch patient. The mean QoL index was 0.462 at baseline and 0.737 at 6 months, indicating a rise in QoL after treatment as well as a long-lasting impact on QoL. To our knowledge, this is only the first study investigating the societal costs of Lisfranc injuries, so more research is needed.
Collapse
Affiliation(s)
- N A C van den Boom
- Maastricht University Medical Centre, Dept. of Trauma Surgery, P. Debyelaan 25, 6229, HX Maastricht, The Netherlands; Maastricht University, Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
| | - A A van den Hurk
- Maastricht University, Faculty of Health, Medicine, and Life Sciences (FHML), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - S M A A Evers
- Maastricht University, Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Maastricht University, Faculty of Health, Medicine, and Life Sciences (FHML), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health, and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands
| | - M Poeze
- Maastricht University Medical Centre, Dept. of Trauma Surgery, P. Debyelaan 25, 6229, HX Maastricht, The Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| |
Collapse
|
7
|
Yi Y, Chaudhari S. Various Flexible Fixation Techniques Using Suture Button for Ligamentous Lisfranc Injuries: A Review of Surgical Options. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1134. [PMID: 37374337 DOI: 10.3390/medicina59061134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Contrary to Lisfranc joint fracture-dislocation, ligamentous Lisfranc injury can lead to additional instability and arthritis and is difficult to diagnose. Appropriate procedure selection is necessary for a better prognosis. Several surgical methods have recently been introduced. Here, we present three distinct surgical techniques for treating ligamentous Lisfranc employing flexible fixation. First is the "Single Tightrope procedure", which involves reduction and fixation between the second metatarsal base and the medial cuneiform via making a bone tunnel and inserting Tightrope. Second is the "Dual Tightrope Technique", which is similar to the "Single Tightrope technique", with additional fixation of an intercuneiform joint using one MiniLok Quick Anchor Plus. Last but not least, the "internal brace approach" uses the SwiveLock anchor, particularly when intercueniform instability is seen. Each approach has its own advantages and disadvantages in terms of surgical complexity and stability. These flexible fixation methods, on the other hand, are more physiologic and have the potential to lessen the difficulties that have been linked to the use of conventional screws in the past.
Collapse
Affiliation(s)
- Young Yi
- Department of Orthopedic Surgery, Seoul Foot and Ankle Center, Inje University Seoul Paik Hospital, 85, 2-ga, Jeo-dong, Jung-gu, Seoul 04551, Republic of Korea
| | - Sagar Chaudhari
- Department of Orthopedic Surgery, K. B. Bhabha Hospital, Bandra, Mumbai 400050, Maharashtra, India
| |
Collapse
|
8
|
Huyke-Hernández FA, Lesmeister N, Yonke B, Mazzuca J. CT and Functional Outcomes of Primarily Ligamentous and Combined Ligamentous-Bony Lisfranc Injuries: A Retrospective Review. J Foot Ankle Surg 2023; 62:317-322. [PMID: 36270883 DOI: 10.1053/j.jfas.2022.08.008] [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: 05/04/2022] [Revised: 08/02/2022] [Accepted: 08/20/2022] [Indexed: 02/03/2023]
Abstract
Lisfranc injuries have been rising in incidence and can cause significant and lasting morbidity. There is no consensus on the optimal surgical treatment for these injuries, be they primarily ligamentous or combined (bony and ligamentous). No study has ever followed Lisfranc injury patients postoperatively using advanced imaging. The purpose of this study was to compare the functional and radiographic outcomes of primarily ligamentous and combined osseous and ligamentous Lisfranc injuries treated operatively with reduction and fixation. We performed a retrospective review of all Lisfranc injuries treated operatively in a single institution over a 6-year period. Injuries were classified as primarily ligamentous or combined by independent evaluation of available computed tomography (CT) or magnetic resonance imaging. Outcomes were measured using the Short Musculoskeletal Function Assessment (SMFA). CT of 29 patients was performed at last follow-up to evaluate reduction and degenerative changes. Of the 56 patients identified, 38 were available for follow-up. The average follow-up was 3.8 years. There were 26 combined injuries and 12 primarily ligamentous injuries. Outcomes were excellent in all patients and there was no statistical difference in SMFA scores in any category between the groups. On follow-up CT, all injuries were anatomically reduced, and 26 of 29 patients had degenerative changes. Our results support that reduction and stable fixation of Lisfranc injuries may be suitable treatment regardless of classification as combined or primarily ligamentous. Future larger-scale prospective studies should be pursued to supplement existing data.
Collapse
Affiliation(s)
- Fernando A Huyke-Hernández
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN; Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, MN
| | - Nicholas Lesmeister
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
| | - Bret Yonke
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN
| | - James Mazzuca
- Department of Orthopaedic Surgery, TRIA Orthopaedic Center, Bloomington, MN; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| |
Collapse
|
9
|
Chen C, Jiang J, Wang C, Zou J, Shi Z, Yang Y. Is the diagnostic validity of conventional radiography for Lisfranc injury acceptable? J Foot Ankle Res 2023; 16:9. [PMID: 36855126 PMCID: PMC9976526 DOI: 10.1186/s13047-023-00608-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Lisfranc injuries mainly involve the tarsometatarsal joint complex and are commonly misdiagnosed or missed in clinical settings. Most medical institutions prefer to use conventional radiography. However, existing studies on conventional radiographs in Lisfranc injury lack a large population-based sample, influencing the validity of the results. We aimed to determine the diagnostic validity and reliability of conventional radiography for Lisfranc injury and whether computed tomography can alter clinical decision-making. METHODS This retrospective study included 307 patients with, and 100 patients without, Lisfranc injury from January 2017 to December 2019. Diagnosis was confirmed using computed tomography. A senior and junior surgeon independently completed two assessments of the same set of anonymised conventional radiographs at least 3 months apart. The surgeons were then asked to suggest one of two treatment options (surgery or conservative treatment) for each case based on the radiographs and subsequently on the CT images. RESULTS All inter- and intra-observer reliabilities were moderate to very good (all κ coefficients > 0.4). The mean (range) true positive rate was 81.8% (73.9%-87.0%), true negative rate was 90.0% (85.0%-94.0%), false positive rate was 10.0% (6.0%-15.0%), false negative rate was 18.2% (13.0%-26.1%), positive predictive value was 96.1% (93.8%-97.8%), negative predictive value was 62.4% (51.5%-69.7%), classification accuracy was 83.8% (76.7%-88.2%), and balanced error rate was 14.1% (10.2%-20.5%). Three-column injuries were most likely to be recognized (mean rate, 92.1%), followed by intermediate-lateral-column injuries (mean rate, 81.5%). Medial-column injuries were relatively difficult to identify (mean rate, 60.7%). The diagnostic rate for non-displaced injuries (mean rate, 76.7%) was lower than that for displaced injuries (mean rate, 95.5%). The typical examples are given. A significant difference between the two surgeons was found in the recognition rate of non-displaced injuries (p = 0.005). The mean alteration rate was 21.9%; the senior surgeon tended to a lower rate (15.6%) than the junior one (28.3%) (p < 0.001). CONCLUSIONS The sensitivity, specificity, and classification accuracy of conventional radiographs for Lisfranc injury were 81.8%, 90.0%, and 83.8%, respectively. Three-column or displaced injuries were most likely to be recognized. The possibility of changing the initial treatment decision after subsequently evaluating computed tomography images was 21.9%. The diagnostic and clinical decision-making of surgeons with different experience levels demonstrated some degree of variability. Protected weight-bearing and a further CT scan should be considered if a Lisfranc injury is suspected and conventional radiography is negative.
Collapse
Affiliation(s)
- Cheng Chen
- grid.24516.340000000123704535Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200092 China ,grid.412528.80000 0004 1798 5117Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, 200233 China
| | - JianTao Jiang
- grid.412528.80000 0004 1798 5117Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, 200233 China ,Department of Orthopedics, Shaoxing Shangyu Hospital of Chinese Medicine, Shaoxing, 312000 China
| | - Cheng Wang
- grid.412528.80000 0004 1798 5117Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, 200233 China
| | - Jian Zou
- grid.412528.80000 0004 1798 5117Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, 200233 China
| | - ZhongMin Shi
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth Peoples Hospital, Shanghai, 200233, China.
| | - YunFeng Yang
- Department of Orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
| |
Collapse
|
10
|
Chopart Joint Injuries: Assessment, Treatment, and 10-Year Results. J Orthop Trauma 2023; 37:e14-e21. [PMID: 35976798 DOI: 10.1097/bot.0000000000002465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate injury patterns and long-term outcomes of midtarsal (Chopart) injuries in a sizeable number of patients. DESIGN Prospective study. SETTING Level 1 trauma center. PATIENTS One hundred twenty-two patients (average age 37.6 years) with 128 Chopart injuries over a 15-year period, 27% of who were polytraumatized. In 47%, more than 1 of the 4 bones of the midtarsal joint was fractured. The navicular and cuboid were fractured most often. Purely ligamentous dislocations occurred in 4%. INTERVENTIONS Operative treatment tailored to the individual fracture pattern was performed in 91.4%. MAIN OUTCOME MEASUREMENTS Foot Function Index, American Orthopaedic Foot and Ankle Society score, SF-36 physical (PCS) and mental component summary (MCS). RESULTS Seventy-three patients with 75 Chopart injuries were available for follow-up at an average of 10.1 years. The Foot Function Index averaged 26.9, the American Orthopaedic Foot and Ankle Society score averaged 71.5, and the SF-36 PCS and MCS averaged 43.5 and 51.2, respectively. Negative prognostic factors were a high injury severity score, work-related accidents, open and multiple fractures, purely ligamentous dislocations, staged surgery, delay of treatment >4 weeks, postoperative infection, and primary or secondary fusion. Open reduction and internal fixation led to significantly better results than attempted closed reduction and percutaneous fixation. Radiographic signs of posttraumatic arthritis were observed in 93%, but only 4.7% of cases required a late fusion at the Chopart joint. CONCLUSIONS Chopart joint injuries lead to functional restrictions in the long term. Purely ligamentous dislocations have the worst prognosis, whereas fractures of a single bone have a favorable outcome after anatomic reduction and internal fixation. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
11
|
Ponkilainen V, Kuitunen I, Liukkonen R, Vaajala M, Reito A, Uimonen M. The incidence of musculoskeletal injuries: a systematic review and meta-analysis. Bone Joint Res 2022; 11:814-825. [DOI: 10.1302/2046-3758.1111.bjr-2022-0181.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aims The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates. Methods PubMed (National Library of Medicine) and Scopus (Elsevier) databases were searched. Articles were eligible for inclusion if they reported incidence rate (or count with population at risk), contained data on adult population, and were written in English language. The number of cases and population at risk were collected, and the pooled incidence rates (per 100,000 person-years) with 95% confidence intervals (CIs) were calculated by using either a fixed or random effects model. Results The screening of titles yielded 206 articles eligible for inclusion in the study. Of these, 173 (84%) articles provided sufficient information to be included in the pooled incidence rates. Incidences of fractures were investigated in 154 studies, and the most common fractures in the whole adult population based on the pooled incidence rates were distal radius fractures (212.0, 95% CI 178.1 to 252.4 per 100,000 person-years), finger fractures (117.1, 95% CI 105.3 to 130.2 per 100,000 person-years), and hip fractures (112.9, 95% CI 82.2 to 154.9 per 100,000 person-years). The most common sprains and dislocations were ankle sprains (429.4, 95% CI 243.0 to 759.0 per 100,000 person-years) and first-time patellar dislocations (32.8, 95% CI 21.6 to 49.7 per 100,000 person-years). The most common injuries were anterior cruciate ligament (17.5, 95% CI 6.0 to 50.2 per 100,000 person-years) and Achilles (13.7, 95% CI 9.6 to 19.5 per 100,000 person-years) ruptures. Conclusion The presented pooled incidence estimates serve as important references in assessing the global economic and social burden of musculoskeletal injuries. Cite this article: Bone Joint Res 2022;11(11):814–825.
Collapse
Affiliation(s)
- Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Ilari Kuitunen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland
| | - Rasmus Liukkonen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Matias Vaajala
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Aleksi Reito
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Mikko Uimonen
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| |
Collapse
|
12
|
Fares A, Orfeuvre B, Al Ezz MA, Pailhe R. An unusual midfoot injury pattern: Navicular-cuneiform and calcaneal-cuboid fracture-dislocation. Trauma Case Rep 2022; 41:100679. [PMID: 35982761 PMCID: PMC9379977 DOI: 10.1016/j.tcr.2022.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/29/2022] Open
Abstract
Fracture-dislocations of the midfoot are relatively rare injuries. We present a case of a 20-year-old man presenting with navicular-cuneiform and calcaneal-cuboid fracture-dislocation of his right foot due to a crush injury during work. The patient's injury was treated by open reduction internal fixation.
Collapse
|
13
|
Reliability of various diastasis measurement methods on weightbearing radiographs in patients with subtle Lisfranc injuries. Skeletal Radiol 2022; 51:801-806. [PMID: 34410434 DOI: 10.1007/s00256-021-03892-8] [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: 06/17/2021] [Revised: 08/06/2021] [Accepted: 08/14/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to evaluate the reliability of the diastasis measurements between the medial cuneiform and the second metatarsal on weightbearing radiography. MATERIALS AND METHODS We retrospectively examined 18 patients who underwent open surgery for subtle Lisfranc injuries. Preoperative weightbearing radiography of the affected and unaffected feet was evaluated in all patients. The diastasis between the medial cuneiform and the second metatarsal was measured in both feet using the following four methods: diastasis between parallel lines, distal point diastasis, middle point diastasis, and proximal point diastasis. Intraclass correlation coefficients with consistency of agreement were calculated to evaluate inter- and intraobserver reliability. RESULTS The intra- and interobserver reliabilities of all four methods were good. Intraclass correlation coefficients for intraobserver reliability ranged from 0.87 to 0.93. Those for interobserver reliability ranged from 0.81 to 0.91. CONCLUSIONS The reliabilities of the diastasis measurement methods between the medial cuneiform and the second metatarsal on weightbearing radiography were good. Measuring the diastasis between the medial cuneiform and the second metatarsal on weightbearing radiography is useful in evaluating subtle injuries when uniform measurement methods are used.
Collapse
|
14
|
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.
Collapse
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
| | | |
Collapse
|
15
|
Vosoughi AR, Kordi Yoosefinejad A, Safaei Dehbarez Y, Kargarshouraki Z, Mahdaviazad H. Evaluating the Validity and Reliability of the Persian Version of American Orthopedic Foot and Ankle Society Midfoot Scale. Foot Ankle Spec 2022:19386400211068242. [PMID: 34991352 DOI: 10.1177/19386400211068242] [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: 10/19/2022]
Abstract
BACKGROUND The use of a valid and reliable outcome scoring system is crucial for evaluating the result of different treatment interventions. The aims of this study were to translate and culturally adapt the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system into the Persian language and assess its validity and reliability. METHOD In total, 57 patients with midfoot injuries were enrolled. Forward-backward translation and cultural adaptation methods were used to develop the Persian version of AOFAS midfoot scoring system. Reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's alpha. The discriminant and convergent validities of the scoring system were assessed using the total score of the mental and physical component of SF-36. RESULTS The mean age of the participants was 46.2 ± 16.3 years. The intra-observer reliability of the totals core of the Persian version of AOFAS midfoot scoring system was 0.96 (confidence interval [CI]: 0.92-0.97) and the inter-observer reliability of the scoring system was 0.90 (CI: 0.86-0.95). The Persian version of AOFAS midfoot scoring system had acceptable convergence with physical component scoring system of SF-36 and its subscales (0.57); moreover, it had acceptable discriminant validity with the mental component of SF-36 and its subscales (0.36). CONCLUSION The Persian version of AOFAS midfoot is a reliable and valid instrument and could be used by Persian language clinicians and researchers. LEVEL OF CLINICAL EVIDENCE 3.
Collapse
Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Kordi Yoosefinejad
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Zeinab Kargarshouraki
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamideh Mahdaviazad
- Family Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
16
|
Management of Lisfranc injury with anterolateral calcaneal compression fracture. Chin Med J (Engl) 2021; 135:727-729. [PMID: 34954714 PMCID: PMC9276426 DOI: 10.1097/cm9.0000000000001924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Indexed: 11/26/2022] Open
|
17
|
Quattrini F, Ciatti C, Gattoni S, Puma Pagliarello C, Ceccarelli F, Maniscalco P. The Use of Low-Profile Angular-Stability Plates in a "Nutcracker" Tarsal Navicular Fracture Combined with a Cuboid Fracture: ORIF Experience. J Funct Morphol Kinesiol 2021; 6:99. [PMID: 34940508 PMCID: PMC8707129 DOI: 10.3390/jfmk6040099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Clear recommendations about the optimal treatment of traumatic tarsal navicular fractures are still very debated in the literature, and this is due to several factors: navicular fractures are rare and often misdiagnosed injuries, they are frequently associated with other fractures or a dislocation of the midfoot, and the current knowledge is based on few papers mainly considering a limited number of cases and dealing with different therapeutic approaches. The treatment of navicular body fractures is controversial and burdened by a high incidence of complications; in particular, Sangeorzan type III comminuted fractures represent a real challenge for the orthopedic surgeon. An accurate preoperative planning, a scrupulous surgical technique aimed at restoring volume and bony anatomy, and the use of low-profile angular-stability plates can lead to optimal clinical and functional results, decreasing the chances of arthritic evolution of mid-foot joints.
Collapse
Affiliation(s)
- Fabrizio Quattrini
- Orthopaedic and Traumatology Department, Ospedale Guglielmo da Saliceto, 29121 Piacenza, Italy; (F.Q.); (C.C.); (S.G.); (C.P.P.)
| | - Corrado Ciatti
- Orthopaedic and Traumatology Department, Ospedale Guglielmo da Saliceto, 29121 Piacenza, Italy; (F.Q.); (C.C.); (S.G.); (C.P.P.)
| | - Serena Gattoni
- Orthopaedic and Traumatology Department, Ospedale Guglielmo da Saliceto, 29121 Piacenza, Italy; (F.Q.); (C.C.); (S.G.); (C.P.P.)
| | - Calogero Puma Pagliarello
- Orthopaedic and Traumatology Department, Ospedale Guglielmo da Saliceto, 29121 Piacenza, Italy; (F.Q.); (C.C.); (S.G.); (C.P.P.)
| | - Francesco Ceccarelli
- Department of Medicine and Surgery, Orthopedic Clinic, University Hospital of Parma, 43100 Parma, Italy;
| | - Pietro Maniscalco
- Orthopaedic and Traumatology Department, Ospedale Guglielmo da Saliceto, 29121 Piacenza, Italy; (F.Q.); (C.C.); (S.G.); (C.P.P.)
| |
Collapse
|
18
|
Kauffmann P, Luhmann L, Alamé K, Schenck B, Bilbault P, Le Borgne P. L’entorse du médiopied (de Chopart). ANNALES FRANCAISES DE MEDECINE D URGENCE 2021. [DOI: 10.3166/afmu-2021-0361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’entorse de Chopart est une lésion traumatique peu connue, sous-estimée et souvent confondue avec une entorse de cheville. Le traumatisme en inversion de la cheville, souvent accompagné d’une flexion plantaire forcée du pied, représente le mécanisme lésionnel le plus fréquent. Son diagnostic repose sur un examen clinique précis nécessitant une bonne connaissance anatomique. Les signes radiographiques sont indirects et souvent discrets. Il s’agit principalement d’arrachements osseux ou de lésions osseuses par impaction ; ils peuvent parfois d’emblée justifier d’un complément scanographique. L’échographie peut également être utile en première intention. A contrario, l’IRM est actuellement réservée aux difficultés diagnostiques. Le traitement de cette pathologie est essentiellement fonctionnel. Il faut cependant connaître les quelques indications pour un traitement orthopédique (immobilisation) comme la présence d’une lésion osseuse de grande taille. Le traitement chirurgical est quant à lui exceptionnel. L’instabilité calcanéocuboïdienne ainsi que l’arthrose du Chopart sont des complications possibles (à moyen ou long terme) mais peu fréquentes.
Collapse
|
19
|
Reliability of measurements assessing the Lisfranc joint using weightbearing computed tomography imaging. Arch Orthop Trauma Surg 2021; 141:775-781. [PMID: 32415387 DOI: 10.1007/s00402-020-03477-5] [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: 01/15/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Subtle Lisfranc joint injuries remain challenging to diagnose in clinical practice. Although of questionable accuracy, bilateral weightbearing radiographs are considered the current gold standard to assess these injuries. However, weightbearing computed tomography (WBCT), which provides clearer visualization of bony landmarks, can also be used for evaluation. This study aims to design a protocol that reliably measures the distance between the medial cuneiform (C1) and second metatarsal (M2) to assess the Lisfranc joint using WBCT imaging. METHODS Two unique methods of measuring the C1-M2 distance were designed that localize the center of the interosseous Lisfranc ligament (ILL, reference point). This reference point was located by (I) measuring a specific distance at the M2 base, or (II) approximating from nearby bony landmarks, on both axial (Ax) and coronal (Cor) WBCT images. Four parameters (I-Ax, I-Cor, II-Ax, and II-Cor) were evaluated for each of 96 specimens. Measurements were recorded by three independent observers and repeated for inter- and intra-observer agreement. RESULTS In total, 96 patient image series were included and assessed in our study with an average age of 46 (19-66, SD 16.1) and average BMI of 25.8 (17.8-30.5, SD 4.3). I-Ax showed excellent agreement for intra-observer evaluation (R = 0.802) and good agreement for inter-observer evaluation (R = 0.727). I-Cor demonstrated excellent inter- (R = 0.814) and intra-observer (R = 0.840) agreement. Good agreement was found for both II-Ax and II-Cor for both intra- (R = 0.730, R = 0.708) and inter-observer (R = 0.705, R = 0.645) evaluation. CONCLUSION Measuring the C1-M2 joint space with coronal WBCT imaging through a protocol that localizes the ILL is reproducible, simple, and can potentially be utilized clinically to evaluate the Lisfranc joint.
Collapse
|
20
|
Herscovici D, Scaduto JM. The LISFRANC JUT: A physical finding of subtle LISFRANC injuries. Injury 2021; 52:1038-1041. [PMID: 33413925 DOI: 10.1016/j.injury.2020.12.026] [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: 07/28/2020] [Revised: 11/01/2020] [Accepted: 12/23/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Low-energy Lisfranc injuries are uncommon and are often misdiagnosed as sprains. This results in a delay for the definitive treatment. The aim of this study is to discuss the physical finding of a midfoot "jut," that can be used to help diagnose subtle Lisfranc injuries, in patients who present with persistent midfoot pain after low-energy trauma. PATIENTS AND METHODS Between January 2015 through December 2019, patients previously diagnosed with a sprain, who were at least six weeks after their original injury, and presented with midfoot pain, were identified. All had a bony prominence on the medial border of the first tarsometatarsal joint, defined as a "jut", which produced pain. Standing radiographs demonstrated subluxation of the tarsometatarsal joint(s). RESULTS Seven patients (5 females/2 males) presented as isolated injuries, with a mean age of 40.4 years. Mechanisms of injury were five falls, one from a sporting event, and one twisting injury. Time to diagnosis, from their date of injury, averaged 9.9 weeks. All underwent fixation. Follow-up averaged 13.7 months. At final follow-up none of the patients developed surgical site infections, wound dehiscence, loosening of implants, loss of reductions or a recurrence of the "jut". None of the patients demonstrated arthrosis and only one patient had a broken screw and declined further surgical intervention. DISCUSSION AND CONCLUSIONS Patients presenting with a history of low-energy trauma, a diagnosis of sprain, continued complaint of foot pain, and a "jut" on the medial border of the midfoot, should be evaluated for a subtle Lisfranc injury.
Collapse
|
21
|
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.
Collapse
|
22
|
Letizia S, Mario M, Isabella P, Giulia F, Danya F, Michele R, Antonio G. Foot fractures and complex trauma of the foot: a case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1077-1085. [PMID: 33392757 DOI: 10.1007/s00590-020-02840-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022]
Abstract
Foot fractures are common injuries. This retrospective study evaluates their frequency, incidence, treatment and outcomes with emphasis on complex trauma of the foot (CTF), an injury that affects soft tissue as well as bone. From 2005 to 2015, 506 patients with foot fractures were treated at our institution; of these, 27 had CTF. The Zwipp score was applied to diagnose CTF, the Gustilo-Anderson classification to grade open fractures and the Tscherne classification to grade closed fractures. Twelve months after the trauma, 20 CTF patients underwent the final X-ray assessment and clinical evaluation with the Visual Analogue Scale Foot and Ankle (VASFA), the Foot Function Index (FFI) and the 12-Item Short Form Survey (SF-12). Data were analyzed with the Spearman rank correlation test. The forefoot was the most frequently involved compartment both in patients with foot fracture and in those with CTF. At 12-month follow-up, the CTF patients showed a VASFA score of 51.5, an FFI of 47.5 and SF-12 scores of 37.9 (physical component summary) and 45.2 (mental component summary). The VASFA score and the FFI showed a significant correlation (rs = 0.84; p = 0.001). CTF is the cause of considerable residual disability and deeply affects quality of life.
Collapse
Affiliation(s)
- Senesi Letizia
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy.
| | - Marinelli Mario
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy
| | - Ponzio Isabella
- UO Ortopedia e Traumatologia, Ospedale San Salvatore, Piazzale Carlo Cinelli 4, 61100, Pesaro, Italy
| | - Facco Giulia
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy
| | - Falcioni Danya
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy
| | - Riccio Michele
- Department of Reconstructive Surgery and Hand Surgery Unit, Ancona Teaching Hospital (AOU Ospedali Riuniti di Ancona), Via Conca 71, 60126, Ancona, Torrette di Ancona, Italy
| | - Gigante Antonio
- Clinical Orthopaedics, Department of Clinical and Molecular Science, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy
| |
Collapse
|
23
|
Ponkilainen VT, Partio N, Salonen EE, Laine HJ, Mäenpää HM, Mattila VM, Haapasalo HH. Outcomes after nonoperatively treated non-displaced Lisfranc injury: a retrospective case series of 55 patients. Arch Orthop Trauma Surg 2021; 141:1311-1317. [PMID: 32960309 PMCID: PMC8295070 DOI: 10.1007/s00402-020-03599-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current knowledge of the role of the nonoperative treatment of Lisfranc injuries is based on a few retrospective case series. Hence, consensus on which patients can be treated nonoperatively does not exist. The aim of this study was to investigate outcomes after nonoperative treatment of Lisfranc injuries. METHODS In this study, patients were collected by recruiting all computer tomography-confirmed Lisfranc injuries treated during a 5-year period at a major trauma hospital. Between 2 and 6 years after suffering the injury, patients completed the visual analogue scale foot and ankle questionnaire. RESULTS In total, 55 patients returned adequately completed questionnaires and were included in the study. Of those, 22 patients had avulsion fractures and 33 had simple non-displaced intra-articular fractures. Of these patients, 30 (55%) scored over 90 points in both the pain and function subscales of the VAS-FA, and 35 (64%) scored over 90 points overall. In addition, three (5%) patients scored under 60 points in both the pain and function subscales of the VAS-FA, and four (7%) scored under 60 points overall. Only one patient with avulsion fractures underwent secondary surgery. CONCLUSION Nonoperative treatment has a role in the treatment of Lisfranc injuries, and the results of our study support the view that avulsion and simple intra-articular fractures with < 2 mm of displacement can be treated nonoperatively with high functional outcomes. The results of nonoperative and operative treatment should be compared in a prospective randomized controlled study setting in future studies. LEVEL OF EVIDENCE IV, retrospective case series.
Collapse
Affiliation(s)
- Ville T Ponkilainen
- Department of Orthopaedics, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Teiskontie 35, PL2000, 33521, Tampere, Finland.
- University of Tampere, School of Medicine, 33520, Tampere, Finland.
| | - Nikke Partio
- Department of Orthopaedics, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Essi E Salonen
- Department of Orthopaedics, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | | | - Heikki M Mäenpää
- Department of Orthopaedics, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Ville M Mattila
- Department of Orthopaedics, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Teiskontie 35, PL2000, 33521, Tampere, Finland
- COXA Hospital for Joint Replacement, Biokatu 6, 33520, Tampere, Finland
| | - Heidi H Haapasalo
- Department of Orthopaedics, Faculty of Medicine and Life Sciences and Tampere University Hospital, University of Tampere, Teiskontie 35, PL2000, 33521, Tampere, Finland
| |
Collapse
|
24
|
Abstract
The reported incidence of Lisfranc injuries is 9.2/100.000 person-years; two-thirds of the injuries are nondisplaced. Tarsometatarsal injuries range from minor sprains and isolated ligamentous injuries to grossly unstable and multiligamentous lesions. High-energy injuries are usually linked with mechanical energy dissipation through the soft tissues. Operative treatment options include open reduction and internal fixation, open reduction with hybrid internal and external fixation, closed reduction with percutaneous internal or external fixation, and primary arthrodesis. Treatment goals are to obtain a painless, plantigrade, and stable foot. Anatomic reduction is a key factor for improved outcomes and decreased rates of post-traumatic arthritis.
Collapse
Affiliation(s)
- Alexandre Leme Godoy-Santos
- Department of Orthopedic Surgery, Faculdade de Medicina, Universidade de São Paulo, Rua Dr Ovídio Pires de Campos 333, Cerqueira Cesar, Sao Paulo, São Paulo 05403-010, Brazil; Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins drive, Iowa City, IA 52242, USA
| |
Collapse
|
25
|
Sripanich Y, Weinberg M, Krähenbühl N, Rungprai C, Saltzman CL, Barg A. Change in the First Cuneiform-Second Metatarsal Distance After Simulated Ligamentous Lisfranc Injury Evaluated by Weightbearing CT Scans. Foot Ankle Int 2020; 41:1432-1441. [PMID: 32819160 DOI: 10.1177/1071100720938331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to investigate the widening between the first cuneiform (C1) and second metatarsal (M2) in a Lisfranc ligamentous complex (LLC) joint injury model subjected to successive ligament dissections evaluated by weightbearing computed tomography (CT) scans. METHODS Twenty-four intact cadaveric feet served as the control (condition 1). Each component of the LLC (dorsal, interosseous, and plantar ligaments-conditions 2, 3, and 4, respectively) were then sequentially dissected. The specimens were equally randomized to 1 of 3 additional dissections (first or second tarsometatarsal [TMT] joint capsule or first-second intercuneiform ligament [ICL]-conditions 5a, 5b, and 5c, respectively). One additional ligament was then randomly transected (eg, condition 6ac-transection of the first TMT capsule and ICL). Finally, the remaining ligament was transected (condition 7). After each dissection, CT scans were acquired under nonweightbearing (NWB, 0 kg), partial-weightbearing (PWB, 40 kg), and full-weightbearing (FWB, 80 kg) conditions. The distance between the lateral border of C1 and the medial border of M2 was assessed to evaluate diastasis. Linear regressions with 95% CIs and converted q values were used to compare the measured data. RESULTS No significant differences were found within the control. In condition 4, an average axial plane widening relative to control of 1.6 mm (95% CI, 1.5-1.8) and 2.1 mm (95% CI, 1.9-2.2) was observed under PWB and FWB. A coronal plane widening of 1.5 mm (95% CI, 1.3-1.6) and 1.9 mm (95% CI, 1.7-2.1) under PWB and FWB, respectively, was measured. A 95% CI of at least a 2-mm widening during PWB was demonstrated in 5c, 6ac, 6bc, and 7. CONCLUSIONS Weightbearing computed tomography (WBCT) scans were used to detect ligamentous Lisfranc injuries in a cadaveric model. Relative axial widening greater than 1.5 mm under PWB conditions could indicate a complete LLC injury. Complete transection of the intercuneiform 1-2 ligament was required to detect a 2-mm widening in the nonweightbearing condition. CLINICAL RELEVANCE This study provides insight on the detection of various severities of LLC injuries using WBCT imaging.
Collapse
Affiliation(s)
- Yantarat Sripanich
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.,Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Maxwell Weinberg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Nicola Krähenbühl
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Chamnanni Rungprai
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | | | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.,Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
26
|
Calcaneocuboid and Naviculocuneiform Dislocation: An Unusual Injury of the Midfoot. Case Rep Orthop 2020; 2020:8818823. [PMID: 33062360 PMCID: PMC7539103 DOI: 10.1155/2020/8818823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/20/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction. Midfoot dislocations are rare traumatic injuries. The best known patterns involve the Lisfranc and Chopart joints, although some other types have been described. Dislocations that occur at the level of the naviculocuneiform and calcaneocuboid joints simultaneously represent a very rare configuration of dislocation. Case Presentation. A 34-year-old man sustained a crush injury to his left foot causing a complete dislocation through the naviculocuneiform and calcaneocuboid joints. Immediate closed reduction and percutaneous pinning were performed, followed by open reduction and stabilization of both joints two weeks later. Anatomical reduction was obtained, and the clinical outcome remained satisfactory 10 months after surgery. Discussion. Anatomical reduction is essential to obtain favorable outcomes in traumatic midfoot injuries. An unusual pattern of midfoot dislocation can be treated according to the same principles as those for classical Lisfranc or Chopart injuries.
Collapse
|
27
|
Neradi D, Sharma S, Patel S, Dhillon MS. Not to Be Missed: Subtle Radiographic Findings of the Ligamentous Lisfranc Injury. J Emerg Med 2020; 59:e143-e147. [PMID: 32814678 DOI: 10.1016/j.jemermed.2020.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Deepak Neradi
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddhartha Sharma
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Patel
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep S Dhillon
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
28
|
Patel MS, Mutawakkil MY, Kadakia AR. Low-Energy Lisfranc Injuries: When to Fix and When to Fuse. Clin Sports Med 2020; 39:773-791. [PMID: 32892966 DOI: 10.1016/j.csm.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Lisfranc injuries can be devastating to the athlete and nonathlete. In the athletic population, minor loss of midfoot stability compromises the high level of function demanded of the lower extremity. The most critical aspect of treatment is identifying the injury and severity of the ligamentous/articular damage. Not all athletes are able to return to their previous level of function. With appropriate treatment, a Lisfranc injury does not mandate the cessation of an athletic career. We focus on the diagnosis and an algorithmic approach to treatment in the athlete discussion the controversy of open reduction and internal fixation versus arthrodesis.
Collapse
Affiliation(s)
- Milap S Patel
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Center for Comprehensive Orthopaedic and Spine Care, 259 East Erie, 13th Floor, Chicago, IL 60611, USA
| | - Muhammad Y Mutawakkil
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Center for Comprehensive Orthopaedic and Spine Care, 259 East Erie, 13th Floor, Chicago, IL 60611, USA
| | - Anish R Kadakia
- Orthopaedic Foot and Ankle Fellowship, Department of Orthopedic Surgery, Northwestern Memorial Hospital, Center for Comprehensive Orthopaedic and Spine Care, Northwestern University, 259 East Erie, 13th Floor, Chicago, IL 60611, USA.
| |
Collapse
|
29
|
Validity and internal consistency of the American Orthopaedic Foot and Ankle Society Midfoot Scale in patients with Lisfranc injury. Foot Ankle Surg 2020; 26:523-529. [PMID: 31255577 DOI: 10.1016/j.fas.2019.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/21/2019] [Accepted: 06/09/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale is an extensively used outcome measure instrument for evaluating outcomes after foot and ankle surgery or trauma. METHODS In total, 117 patients with Lisfranc injury completed the AOFAS Midfoot Scale and the Visual Analogue Scale Foot and Ankle (VAS-FA) instruments. Internal consistency (correlation between different items), floor and ceiling values, convergent validity, item threshold distribution, and the coverage (item difficulty) of the AOFAS Midfoot scale were tested. RESULTS AOFAS Midfoot Scale had high convergent validity and acceptable internal consistency (Cronbach's alpha >0.70). The ceiling effect was confirmed. The person-item distribution indicated that the scale had a lack of coverage and targeting in our sample. CONCLUSIONS Our data suggests that the AOFAS Midfoot Scale has acceptable validity and internal consistency. However, due to the lack of coverage and targeting, it should not be the primary outcome measure to be used to evaluate the outcomes after Lisfranc injury in the future studies.
Collapse
|
30
|
Lisfranc injuries: Incidence, mechanisms of injury and predictors of instability. Foot Ankle Surg 2020; 26:535-540. [PMID: 31257042 DOI: 10.1016/j.fas.2019.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/15/2019] [Accepted: 06/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND In Lisfranc injuries the stability of the tarsometatarsal joints guides the treatment of the injury. Determining the stability, especially in the subtle Lisfranc injuries, can be challenging. The purpose of this study was to identify incidence, mechanisms of injury and predictors for instability in Lisfranc injuries. METHODS Eighty-four Lisfranc injuries presenting at Oslo University Hospital between September 2014 and August 2015 were included. The diagnosis was based on radiologically verified injuries to the tarsometatarsal joints. Associations between radiographic findings and stability were examined. RESULTS The incidence of Lisfranc injuries was 14/100,000 person-years, and only 31% were high-energy injuries. The incidence of unstable injuries was 6/100,000 person-years, and these were more common in women than men (P = 0.016). Intraarticular fractures in the two lateral tarsometatarsal joints increased the risk of instability (P = 0.007). The height of the second tarsometatarsal joint was less in the unstable injuries than in the stable injuries (P = 0.036). CONCLUSION The incidence of Lisfranc injuries in the present study is higher than previously published. The most common mechanism of injury is low-energy trauma. Intraarticular fractures in the two lateral tarsometatarsal joints, female gender and shorter second tarsometatarsal joint height increase the risk of an unstable injury. LEVEL OF EVIDENCE Level III, cross-sectional study.
Collapse
|
31
|
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.
Collapse
|
32
|
Daniels TR, Wilson IR, Fu JM. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2020; 102:856-865. [PMID: 32187125 DOI: 10.2106/jbjs.20.00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | | |
Collapse
|
33
|
Engelmann EWM, Rammelt S, Schepers T. Fractures of the Cuboid Bone: A Critical Analysis Review. JBJS Rev 2020; 8:e0173. [PMID: 32304497 DOI: 10.2106/jbjs.rvw.19.00173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cuboid fractures rarely occur in isolation, and a high index of suspicion for the presence of Chopart, Lisfranc, or complex midfoot injuries should be raised. The cuboid is the cornerstone of the lateral column and acts as a bridge between the lateral column and the transverse plantar arch. Its most important role is maintenance of lateral column length and associated motion in the midtarsal and tarsometatarsal joints. To date, a classification system that is validated for clinical practice (i.e., guidance for management and prediction of outcome and prognosis) is lacking. The principles of operative treatment are restoration of articular congruity, lateral column length, and stability of the Chopart and Lisfranc joints. Nonoperative management is reserved for nondisplaced articular fractures (<1 mm) or avulsion fractures that are caused by low-energy trauma.
Collapse
Affiliation(s)
- Esmee W M Engelmann
- Trauma Unit, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Stefan Rammelt
- University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Tim Schepers
- Trauma Unit, Amsterdam University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
34
|
Inter- and intraobserver reliability of non-weight-bearing foot radiographs compared with CT in Lisfranc injuries. Arch Orthop Trauma Surg 2020; 140:1423-1429. [PMID: 32140830 PMCID: PMC7505866 DOI: 10.1007/s00402-020-03391-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Injury of the tarsometatarsal (TMT) joint complex, known as Lisfranc injury, covers a wide range of injuries from subtle ligamentous injuries to severely displaced crush injuries. Although it is known that these injuries are commonly missed, the literature on the accuracy of the diagnostics is limited. The diagnostic accuracy of non-weight-bearing radiography (inter- or intraobserver reliability), however, has not previously been assessed among patients with Lisfranc injury. METHODS One hundred sets of foot radiographs acquired due to acute foot injury were collected and anonymised. The diagnosis of these patients was confirmed with a CT scan. In one-third of the radiographs, there was no Lisfranc injury; in one-third, a nondisplaced (< 2 mm) injury; and in one-third, a displaced injury. The radiographs were assessed independently by three senior orthopaedic surgeons and three orthopaedic surgery residents. RESULTS Fleiss kappa (κ) coefficient for interobserver reliability resulted in moderate correlation κ = 0.50 (95% CI: 0.45- 0.55) (first evaluation) and κ = 0.58 (95% CI: 0.52-0.63) (second evaluation). After three months, the evaluation was repeated and the Cohen's kappa (κ) coefficient for intraobserver reliability showed substantial correlation κ = 0.71 (from 0.64 to 0.85). The mean (range) sensitivity was 76.1% (60.6-92.4) and specificity was 85.3% (52.9-100). The sensitivity of subtle injuries was lower than severe injuries (65.4% vs 87.1% p = 0.003). CONCLUSIONS Diagnosis of Lisfranc injury based on non-weight-bearing radiographs has moderate agreement between observers and substantial agreement between the same observer in different moments. A substantial number (24%) of injuries are missed if only non-weight-bearing radiographs are used. Nondisplaced injuries were more commonly missed than displaced injuries, and therefore, special caution should be used when the clinical signs are subtle. LEVEL OF EVIDENCE III.
Collapse
|
35
|
Vosoughi AR, Akbarzadeh A. Concomitant old complex fracture–dislocation of the first metatarsophalangeal, Lisfranc, and naviculocuneiform joints. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2019. [DOI: 10.1177/2210491719860246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Old simultaneous complex fracture–dislocation of the first metatarsophalangeal (MTP), Lisfranc, and naviculocuneiform joints as an overwhelming injury has not been reported in the literature yet. In a 29-year-old man, 6 months following the trauma, the medial column of foot was reconstructed using iliac tricortical bone graft from navicular to the first metatarsal. Arthrodesis of the second and third tarsometatarsal joints and resection arthroplasty of the first MTP joint were done. His clinical and radiographic evaluation after 18 months revealed an acceptable function with returning to pre-injury job but with some limitations in recreational activities. Level of evidence: level 4
Collapse
Affiliation(s)
- Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Akbarzadeh
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
36
|
Kennelly H, Klaassen K, Heitman D, Youngberg R, Platt SR. Utility of weight‐bearing radiographs compared to computed tomography scan for the diagnosis of subtle Lisfranc injuries in the emergency setting. Emerg Med Australas 2019; 31:741-744. [DOI: 10.1111/1742-6723.13237] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/06/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Hannah Kennelly
- Department of Orthopaedic SurgeryGold Coast Hospital and Health Service Gold Coast Queensland Australia
| | - Kassey Klaassen
- Department of Orthopaedic SurgeryGold Coast Hospital and Health Service Gold Coast Queensland Australia
| | - Daniel Heitman
- Department of Orthopaedic SurgeryGold Coast Hospital and Health Service Gold Coast Queensland Australia
| | - Rhys Youngberg
- Department of Orthopaedic SurgeryGold Coast Hospital and Health Service Gold Coast Queensland Australia
| | - Simon R Platt
- Department of Orthopaedic SurgeryGold Coast Hospital and Health Service Gold Coast Queensland Australia
| |
Collapse
|