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Brahman S Sivakumar, Vincent V G An, Colby Oitment, Mark Myerson
Lisfranc injuries are relatively uncommon. No specific incidence of subtle injuries has been reported; however, almost one-third are missed on initial review. These missed injuries are a common cause of litigation. Although seen in high-energy injuries with direct application of forces, they are also associated with lower-energy indirect mechanisms, often on the athletic field. This article provides a topical review of subtle Lisfranc disruptions, focusing on contemporary perspectives, and describes a modification to the most prevalent classification system...
February 16, 2018: Orthopedics
S van Hoeve, G Stollenwerck, P Willems, M A Witlox, K Meijer, M Poeze
INTRODUCTION: Lisfranc injuries involve any bony or ligamentous disruption of the tarsometatarsal joint. Outcome results after treatment are mainly evaluated using patient-reported outcome measures (PROM), physical examination and radiographic findings. Less is known about the kinematics during gait. METHODS: Nineteen patients (19 feet) treated for Lisfranc injury were recruited. Patients with conservative treatment and surgical treatment consisting of open reduction and internal fixation (ORIF) or primary arthrodesis were included...
July 18, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Nathan C Ho, Sophia N Sangiorgio, Spenser Cassinelli, Stephen Shymon, John Fleming, Virat Agrawal, Edward Ebramzadeh, Thomas G Harris
BACKGROUND: To obtain adequate fixation in treating Lisfranc soft tissue injuries, the joint is commonly stabilized using multiple transarticular screws; however iatrogenic injury is a concern. Alternatively, two parallel, longitudinally placed plates, can be used to stabilize the 1st and 2nd tarsometatarsal joints; however this may not provide adequate stability along the Lisfranc ligament. Several biomechanical studies have compared earlier methods of fixation using plates to the standard transarticular screw fixation method, highlighting the potential issue of transverse stability using plates...
August 23, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Grace C Kunas, William Probasco, Amgad M Haleem, Jayme C Burket, Emilie R C Williamson, Scott J Ellis
BACKGROUND: The aim of this study was to assess the inferior talus-superior talus (inf-tal-sup-tal) angle (previously proven reliable in multiplanar-weight bearing imaging (MP-WB)) on both computed tomography (CT) and MP-WB scans. We sought to compare the angle between the two modalities in both AAFD and control groups, as well as to compare the groups to each other. METHODS: Inf-tal-sup-tal angles were compared between a stage II AAFD group (n=38) with routine MP-WB and CT scans and a control group (n=20) with preoperative CT scans for lisfranc injuries and normal hindfoot alignment after healing...
June 12, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Xunqi Cheow, Kai Yet Lam
This study evaluates the midterm outcomes of Lisfranc injuries in adolescents operatively treated with Kirschner wire or screw fixation. Eight adolescent patients with Lisfranc injuries operatively treated in a single institution were included in this study. The mean duration of follow-up was 3.8 years. Analysis of radiographs with respect to the degree of initial displacement and final reduction was carried out in terms of the intermetatarsal distances. All cases were scored functionally using the American Orthopaedic Foot and Ankle Society Midfoot Scale...
February 20, 2018: Journal of Pediatric Orthopedics. Part B
Katherine M Edenfield
The midfoot and forefoot are the regions of the foot distal to the talus and calcaneus and are critical to weight bearing and movement. They help support the arch of the foot, provide shock absorption, and convert vertically oriented forces into horizontal forward and propulsive movement. A spectrum of acute, subacute, and chronic conditions in these regions can cause pain and decreased function. A thorough history and physical examination should include foot and leg biomechanics, alignment, and posture in addition to palpation of painful areas...
February 2018: FP Essentials
Tun Hing Lui
Tarsometatarsal (Lisfranc) destruction of the tarsometatarsal articulation of the lesser rays is most commonly due to midfoot Charcot neuroarthropathy. Tarsometatarsal arthrodesis is indicated when conservative management cannot relieve the symptoms. The purpose of this Technical Note is to describe a minimally invasive approach of arthroscopic arthrodesis of the destructed lesser ray tarsometatarsal joints. The arthroscopic procedure is performed through the lateral and P1-2 Lisfranc portals. It has the advantages of better cosmesis, less wound complication, less bone resection, and more thorough joint debridement...
October 2017: Arthroscopy Techniques
Benedict Swartman, Dirk Frere, Wei Wei, Marc Schnetzke, Stephan Grechenig, Amir Matityahu, Nils Beisemann, Holger Keil, Jochen Franke, Paul Alfred Grützner, Sven Yves Vetter
BACKGROUND: Indirect screw fixation of the sustentaculum tali in the lateral-medial direction can be challenging due to the complex calcaneal anatomy. A novel 2-dimensional (2D) projection-based software application detects Kirschner wires (K-wires) and visualizes their intended direction as a colored trajectory. The aim of this prospectively randomized cadaver study was to investigate whether the software would facilitate the indirect K-wire placement in the sustentaculum tali. METHODS: In 20 cadaver foot specimens, K-wires were placed indirectly in the sustentaculum tali by an experienced and an inexperienced surgeon, with and without using the application...
January 1, 2018: Foot & Ankle International
Maxwell W Weinberg, Nicola Krähenbühl, Nathan P Davidson, Christopher J Hanrahan, Alexej Barg
Avulsion fractures of the first metatarsal (MT1) base at the peroneus longus (PL) tendon attachment are rare and may be undiagnosed during an emergency visit. If the injury is not treated properly, chronic pain or persistent impairment for inversion and plantar-flexion of the first ray may occur. This case report presents a 30-year-old woman who presented 10 weeks post trauma to a foot and ankle surgeon due to a swollen right midfoot with diffuse tenderness over the medial Lisfranc joint. Further evaluation showed an isolated avulsion fracture of the first metatarsal, which was undiagnosed during the emergent visit following the accident...
January 11, 2018: Skeletal Radiology
Andrew Philpott, Callum Lawford, Simon C Lau, Simon Chambers, Michael Bozin, Andrew Oppy
BACKGROUND: Open reduction and internal fixation of Lisfranc injuries has typically used multiple longitudinal incisions or a single transverse incision to approach the tarso-metatarsal joint (TMTJ). The incidence of wound-related complications is considerable. We describe a novel single-incision approach that utilizes subcutaneous windows to the medial TMTJ. METHODS: A retrospective review identified 150 patients who underwent open reduction and internal fixation for Lisfranc injuries, via the modified dorsal approach, at our center between January 2011 and June 2016...
January 1, 2018: Foot & Ankle International
Joshua C Rozell, Matthew Chin, Derek J Donegan, Michael W Hast
There currently exists an array of operative strategies to manage Lisfranc injuries. Modular fixation systems present surgeons with a choice between fully threaded solid cortical (FSC) and partially threaded cannulated cancellous (PCC) bone screws when using a transarticular screw approach. It is currently unknown how screw design influences fixation strength in Lisfranc reconstructions. The purpose of this study was to evaluate the biomechanical differences of FSC and PCC screws using a cadaveric model of a simulated Lisfranc injury and controlled benchtop experiments...
January 8, 2018: Orthopedics
Rachel H Albright, Sarah Haller, Erin Klein, Jeffrey R Baker, Lowell Weil, Lowell S Weil, Adam E Fleischer
The purpose of the present study was to determine whether surgical intervention with open reduction internal fixation (ORIF) or primary arthrodesis (PA) for Lisfranc injuries is more cost effective. We conducted a formal cost-effectiveness analysis using a Markov model and decision tree to explore the healthcare costs and health outcomes associated with a scenario of ORIF versus PA for 45 years postoperatively. The outcomes assessed included long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained...
December 20, 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Amol Saxena, Deann Hofer
This report presents an innovative surgical technique for the correction of cuboid-metatarsal subluxation at the level of the lateral Lisfranc joint. This stabilization technique reinforces the dorsal fourth tarsometatarsal ligament by incorporating sutures and anchors, establishing a more stable joint. The data from 5 female patients undergoing stabilization using a suture anchor construct were reviewed. All 5 patients were able to resume their activities, including the adolescent athletes. Anatomic reconstruction of the dorsal fourth tarsometatarsal ligament complex can lead to full mechanical and functional stability, which ultimately allows for a return to activity, even in highly demanding sports and athletes...
March 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Dolfi Herscovici, Julia M Scaduto
INTRODUCTION: The aims of this study were to (1) describe the use of the K-wire for the initial management of high-energy Lisfranc dislocations or fracture dislocations, (2) to evaluate whether this standalone technique allowed for adequate reduction of these injuries, (3) to evaluate whether reductions were maintained until definitive fixation was performed, (4) and to determine if it contributed to any increase in complications prior to or after definitive fixation. PATIENTS AND METHODS: A retrospective review was performed on all patients who presented with tarsometatarsal injuries from January 2005 through June 2015...
November 16, 2017: Injury
Stephanie Wössner, Kirsten Weber, Anna C Steinbeck, Markus Oberhauser, Matthias Feuerecker
BACKGROUND AND PURPOSE: The purpose of this case report is to describe a multimodal pain therapeutic concept including the adjunct use of pregabalin in a 4.5 year-old child after forefoot amputation. Phantom limb pain and sensation is a complex pain syndrome that is difficult to treat and prevent. 70-75% of all children develop such a pain syndrome after amputation. We describe here a paediatric patient who underwent forefoot amputation following traumatic foot injury and received multimodal pain therapy including pregabalin...
October 2017: Scandinavian Journal of Pain
Rachel J Shakked
No abstract text is available yet for this article.
September 2017: JBJS Reviews
Raúl De Los Santos-Real, Fernando Canillas, Jesús Varas-Navas, Patricia Morales-Muñoz, Patricia Barrio-Sanz, Mónica Medina-Santos
The current classifications of "Lisfranc injury" can be purely ligamentous (low-grade midfoot sprains) or involve the osseous and articular structures (high-grade Lisfranc fracture displacements). The first type is often difficult to detect. If these patients are not properly treated, long-term disability can result. The rate of missed or delayed diagnoses has ranged from 13% to 24%, primarily owing to the subtlety of the radiographic findings. This is relatively more common in cases of subtle ligamentous injury (19%)...
November 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Michael P Hawkinson, David J Tennent, Jeffrey Belisle, Patrick Osborn
BACKGROUND: Traumatic injuries to the tarsometatarsal or Lisfranc joints can be complex problems associated with long-term morbidity. Currently there is no clear consensus regarding optimal fixation methods. The purpose of this study was to evaluate the association between time from injury to treatment and treatment method with outcome. It is hypothesized that patients who underwent open reduction internal fixation (ORIF) more acutely would have higher return to duty rates. METHODS: This study is a retrospective review of 171 low-energy closed tarsometatarsal dislocations and fracture dislocations in patients identified using a Department of Defense trauma registry...
October 2017: Foot & Ankle International
Simon Lau, Catherine Guest, Marcus Hall, Mark Tacey, Samuel Joseph, Andrew Oppy
OBJECTIVE: To identify whether transarticular screws, dorsal bridging plates or a combination of the 2 result in the best functional outcome after Lisfranc injury. DESIGN: Case series. SETTING: Level one trauma center. PATIENTS: Fifty patients who underwent surgical fixation of Lisfranc injuries over a 6-year period were retrospectively reviewed. INTERVENTION: One of 3 treatment arms: transarticular screw fixation alone, dorsal bridge plating alone or a combination of dorsal bridge and transarticular screw fixation...
August 2017: Journal of Orthopaedic Trauma
Dong-Kyo Seo, Ho-Seong Lee, Ki Won Lee, Suk Kyu Lee, Sang-Bum Kim
BACKGROUND: A midfoot sprain can be easily missed because of minimal findings on initial radiographs, which are almost universally nonweightbearing. We investigated preoperative nonweightbearing plain radiographic images in patients who were found to have unstable subtle Lisfranc injuries. METHODS: We retrospectively reviewed 51 patients who were operated on between February 2004 and March 2015. Abnormal preoperative radiographic findings and intraoperative instability were compared...
October 2017: Foot & Ankle International
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