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Wunder J, Schirdewahn C, Griger D, Schnabl M, von Rüden C. [Lisfranc injuries]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:665-676. [PMID: 39079994 DOI: 10.1007/s00113-024-01467-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/16/2024]
Abstract
Lisfranc injuries are rare but severe injuries of the foot. They range from ligament sprain to complex fracture dislocations. Etiologically, a distinction is made between indirect and direct force and between high-energy and low-energy trauma. Inadequate diagnostics (injuries overlooked or misinterpreted) can lead to painful posttraumatic osteoarthritis, chronic instability and deformity of the foot. A fracture, malalignment and unclear findings in conventional radiological diagnostics necessitate computed tomography imaging including 3D reconstruction. Lisfranc injuries are often associated with accompanying pathologies of the foot that also need to be addressed. Only stable non-displaced fractures can be treated conservatively. Depending on the injury pattern, surgical treatment is performed percutaneously, minimally invasive or open. The prognosis following Lisfranc injury is determined by the severity of damage and the quality of reconstruction.
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Affiliation(s)
- Johannes Wunder
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Weiden, Söllnerstr. 16, 92637, Weiden in der Oberpfalz, Deutschland
| | - Christoph Schirdewahn
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Weiden, Söllnerstr. 16, 92637, Weiden in der Oberpfalz, Deutschland
| | - David Griger
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Weiden, Söllnerstr. 16, 92637, Weiden in der Oberpfalz, Deutschland
| | - Matthias Schnabl
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Weiden, Söllnerstr. 16, 92637, Weiden in der Oberpfalz, Deutschland
| | - Christian von Rüden
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Weiden, Söllnerstr. 16, 92637, Weiden in der Oberpfalz, Deutschland.
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
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Mathur V, Osei-Hwedieh D, Sayyed Hosseinian SH, Bejarano-Pineda L, Kaiser P, Raduan F, Kwon JY, Ashkani-Esfahani S, Waryasz GR. Use of Bio-integrative Screws for Fixation of Lisfranc Instability; Pros and Cons from Surgeons' Point of View in a Cadaver Study. THE ARCHIVES OF BONE AND JOINT SURGERY 2024; 12:51-57. [PMID: 38318310 PMCID: PMC10838575 DOI: 10.22038/abjs.2023.73584.3410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/21/2023] [Indexed: 02/07/2024]
Abstract
Objectives Majority of Lisfranc fracture-dislocations require anatomic reduction and rigid internal fixation to prevent debilitating sequelae. Current methods include solid screws and flexible fixations which have been in use for many years. Biointegrative screw is a newer option that has not yet been thoroughly investigated for its effectiveness for Lisfranc injuries. Methods The ligaments of the Lisfranc complex were resected in eight lower-leg cadaveric specimens. This was done by eight foot and ankle surgeons individually. Distraction forces were applied from opposite sides at the joint to replicate weight bearing conditions. Three methods of fixation - flexible fixation, metal, and biointegrative screws- were evaluated. The diastasis and area at the level of the ligament were measured at four conditions (replicated injury and each type of fixation) in neutral and distraction conditions using fluoroscopy images. The Wilcoxon test and Kruskal Wallis test were used for comparison. P value <0.05 was considered statistically significant. Results The diastasis value for the transected ligament scenario (2.47 ± 0.51 mm) was greater than those after all three fixation methods without distraction (2.02 ± 0.5 for flexible fixation, 1.72 ± 0.63 mm for metal screw fixation and 1.67 ± 0.77 mm for biointegrative screw fixation). The transected ligament diastasis was also greater than that for metal screw (1.61 ± 1.31mm) and biointegrative screws (1.69 ± 0.64 mm) with distraction (p<0.001). The area at the level of the ligament showed higher values for transected ligament (32.7 ± 13.08 mm2) than the three fixatives (30.75 ± 7.42 mm2 for flexible fixation, 30.75 ± 17.13 mm2 for metal screw fixation and 29.53 ± 9.15 mm2 for biointegrative screw fixation; p<0.05). Conclusion Metal screws, flexible fixation and biointegrative screws showed comparable effectiveness intra-op, in the correction of diastasis created as a consequence of Lisfranc injury.
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Affiliation(s)
- Vasundhara Mathur
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Equal Contributions; Co-first Authors
| | - David Osei-Hwedieh
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Equal Contributions; Co-first Authors
| | - Sayyed Hadi Sayyed Hosseinian
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Equal Contributions; Co-first Authors
| | - Lorena Bejarano-Pineda
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Philip Kaiser
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Fernando Raduan
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John Y. Kwon
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- FARIL-SORG Collaborative, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Co-Senior Authors
| | - Gregory R. Waryasz
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Co-Senior Authors
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