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Saito GH, Nishikawa DRC, de Oliveira AS, Fairbanks PJ, Moreira Mendes AA, Prado MP. Results of Lisfranc Injuries Treated With Interosseous Suture Button Fixation With a Minimum 5-Year Follow-Up. Foot Ankle Int 2025; 46:506-513. [PMID: 40077945 DOI: 10.1177/10711007251322166] [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: 03/14/2025]
Abstract
BACKGROUND Open reduction and internal fixation or primary arthrodesis are considered gold standards for treating Lisfranc injuries. However, several drawbacks are associated with these procedures, such as joint motion loss and potential cartilage damage. More recently, the suture button emerged as an alternative treatment for ligamentous Lisfranc injuries, which can be used either alone or in combination with traditional techniques, with the potential to mitigate some of these potential disadvantages. The primary outcome of the present study was to evaluate the functional outcomes of 20 patients treated with the suture button technique for Lisfranc injuries over a medium- to long-term follow-up period. The secondary outcome was to assess and describe the complications associated with this procedure. METHODS A retrospective review was conducted on 20 patients who underwent operation for acute Lisfranc injuries using the interosseous suture button technique between 2013 and 2019. The mean follow-up was 83 months (range 60-126). Clinical evaluation involved the assessment of complications, reoperations, visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores, patient satisfaction, and ability to return to previous activities. Radiographic analysis was performed aiming to evaluate reduction maintenance and osteoarthritis development. RESULTS Patients demonstrated excellent outcomes with an average VAS of 0.50 and a mean AOFAS midfoot score of 95.5. Incomplete reduction was the only factor we identified influencing lower VAS and AOFAS scores. Most complications were minor and solved with conservative treatment. More serious complications, such as loss of reduction and posttraumatic arthritis were observed in 2 patients each. CONCLUSION In this small series with a relatively long follow-up, we found that the use of an interosseous suture button technique was a reliable method to treat acute Lisfranc injuries, resulting in satisfactory clinical and functional outcomes. However, outcomes including posttraumatic arthritis and loss of reduction raise remain of concern.
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Bowlby MA. Subtle Lisfranc Injuries. Clin Podiatr Med Surg 2025; 42:207-221. [PMID: 39988388 DOI: 10.1016/j.cpm.2024.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Abstract
Subtle Lisfranc injuries are commonly overlooked, and the severity of the injury is often underestimated. Lisfranc injuries can cause severe pain and debilitation if missed and not treated. Patients with midfoot pain following even a minor trauma should be evaluated for a Lisfranc injury with bilateral weightbearing radiographs when they are able to tolerate. There should be a low threshold for open reduction with internal fixation in the active, healthy patient population. Surgical technique is described. Primary fusion may be considered in more severe cases as well as those where the diagnosis is delayed.
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Affiliation(s)
- Melinda A Bowlby
- Department of Orthopedic Surgery, Foot and Ankle Surgery, Kaiser Permanente Medical Center, 2500 Merced Street, 4th Floor, San Leandro, CA 94577, USA.
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Poutoglidou F, van Groningen B, McMenemy L, Elliot R, Marsland D. Acute Lisfranc injury management. Bone Joint J 2024; 106-B:1431-1442. [PMID: 39615511 DOI: 10.1302/0301-620x.106b12.bjj-2024-0581.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2025]
Abstract
Lisfranc injuries were previously described as fracture-dislocations of the tarsometatarsal joints. With advancements in modern imaging, subtle Lisfranc injuries are now more frequently recognized, revealing that their true incidence is much higher than previously thought. Injury patterns can vary widely in severity and anatomy. Early diagnosis and treatment are essential to achieve good outcomes. The original classification systems were anatomy-based, and limited as tools for guiding treatment. The current review, using the best available evidence, instead introduces a stability-based classification system, with weightbearing radiographs and CT serving as key diagnostic tools. Stable injuries generally have good outcomes with nonoperative management, most reliably treated with immobilization and non-weightbearing for six weeks. Displaced or comminuted injuries require surgical intervention, with open reduction and internal fixation (ORIF) being the most common approach, with a consensus towards bridge plating. While ORIF generally achieves satisfactory results, its effectiveness can vary, particularly in high-energy injuries. Primary arthrodesis remains niche for the treatment of acute injuries, but may offer benefits such as lower rates of post-traumatic arthritis and hardware removal. Novel fixation techniques, including suture button fixation, aim to provide flexible stabilization, which theoretically could improve midfoot biomechanics and reduce complications. Early findings suggest promising functional outcomes, but further studies are required to validate this method compared with established techniques. Future research should focus on refining stability-based classification systems, validation of weightbearing CT, improving rehabilitation protocols, and optimizing surgical techniques for various injury patterns to ultimately enhance patient outcomes.
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Affiliation(s)
- Freideriki Poutoglidou
- Department of Trauma & Orthopaedics, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Bart van Groningen
- Department of Trauma & Orthopaedics, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Louise McMenemy
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
| | - Robin Elliot
- Department of Trauma & Orthopaedics, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Daniel Marsland
- Department of Trauma & Orthopaedics, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
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Choi JY, Suh JS, Jung YH. Effect of dorsoplantar miniscrew fixation of the second metatarsal base fracture on residual diastases in acute lisfranc fracture-dislocation. INTERNATIONAL ORTHOPAEDICS 2024; 48:2911-2921. [PMID: 39297967 DOI: 10.1007/s00264-024-06320-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 09/08/2024] [Indexed: 09/21/2024]
Abstract
PURPOSE This study aimed to evaluate and compare the clinico-radiographic outcomes between two techniques for acute Lisfranc fracture-dislocation with a large, displaced second metatarsal base plantar fracture: isolated Lisfranc screw fixation versus Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base. METHODS We retrospectively compared the clinico-radiographic outcome between patients who underwent isolated Lisfranc screw fixation (Group 1, 26 patients) and those who underwent Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base (Group 2, 23 patients). The main outcome measurements were the postoperative distance between the medial cuneiform and second metatarsal base on standing anteroposterior foot radiographs, known as the C1-M2 distance. Residual diastasis was defined as C1-M2 distance ≥ 2 mm on the affected side compared with that on the contralateral side. We also assessed the Foot and Ankle Ability Measure (FAAM)-activities of daily living (ADL) and sports subscale scores at three, six and ≥ 18 months postoperatively. RESULTS At the final follow-up, the mean C1-M2 distance on the affected side compared with that on the contralateral side was significantly greater in Group 1 than in Group 2 (3.9 versus 0.7 mm, P = 0.027). Furthermore, Group 1 showed a higher incidence of residual diastases at the final follow-up (69.2%) than the Group 2 (13.0%, P < 0.001). The FAAM-ADL scores at the final follow-up did not differ significantly between the groups (P = 0.518), but the FAAM Sports score was significantly higher in Group 2 than in Group 1 (P = 0.001). CONCLUSIONS The postoperative C1-M2 distance was better maintained with Lisfranc joint fixation with dorsoplantar miniscrew fixation of the second metatarsal base than with isolated Lisfranc screw fixation. We recommend that surgeons exercise caution when dealing with a second metatarsal plantar fracture and consider performing secure fixation using the dorsoplantar miniscrew technique for improved clinical outcomes.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea.
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Young Ho Jung
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea
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Cardenas C, McIver ND, Nelson J, Ahmad A, Chavez T, Gross J, Salas C, Gavin K. The Use of Knotless Suture Tape Construct vs Screw Fixation for Lisfranc Injuries: A Cadaveric Biomechanical Study. Foot Ankle Int 2024; 45:896-904. [PMID: 38798115 PMCID: PMC11382486 DOI: 10.1177/10711007241250024] [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] [Indexed: 05/29/2024]
Abstract
BACKGROUND Lisfranc injuries are often treated with open reduction and internal fixation using rigid fixation techniques. The use of flexible fixation to stabilize the Lisfranc joint is a newer technique. The purpose of this cadaveric study is to compare the amount of diastasis at the Lisfranc interval under diminished physiologic loads when treated with a knotless suture tape construct and a solid screw. METHODS Ten cadavers (20 feet) had native motion at the intact Lisfranc interval assessed at multiple increasing loads (69, 138, and 207 N). The Lisfranc ligamentous complex was then disrupted, and testing repeated to evaluate the amount of diastasis. Randomization was performed to determine the type of fixation for each cadaver: solid screw or knotless suture tape construct. Once fixation was completed, specimens were cyclically loaded for 10 000 cycles at loads, and diastasis was quantified after each load cycle to compare the interventions. Diastasis was measured using motion tracking cameras and retroreflective marker sets. A non-inferiority statistical analysis was performed. RESULTS Diastasis mean values were confirmed to be >2 mm for all load bearing conditions in the injury model. Posttreatment, diastasis was significantly reduced when compared to the sectioned conditions (P < .01) for both treatment options. Non-inferiority analyses showed that the knotless suture tape construct did not perform inferior to screw fixation for diastasis at the Lisfranc interval at any of the compared load states. CONCLUSION Under the loads tested, there is no significant difference in diastasis at the Lisfranc interval when treating ligamentous Lisfranc injuries with a knotless suture tape construct or solid screws. Both reduced diastasis from the injured state and were not different from the intact state. CLINICAL RELEVANCE In this cadaveric model with ligamentous Lisfranc injury, diastasis of a knotless suture tape construct is compared to solid screw fixation as tested.
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Affiliation(s)
- Cesar Cardenas
- The Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, USA
| | - Natalia D McIver
- The Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, USA
| | - Jessica Nelson
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Aamir Ahmad
- The Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, USA
| | - Tyler Chavez
- The Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, USA
| | - Jessica Gross
- The Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, USA
| | - Christina Salas
- The Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, USA
| | - Katherine Gavin
- The Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM, USA
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Lachance AD, Giro ME, Edelstein A, Lee W. Suture button fixation yields high levels of patient reported outcomes, return to sport, and stable fixation in isolated Lisfranc injuries: A systematic review. J ISAKOS 2023; 8:474-483. [PMID: 37611870 DOI: 10.1016/j.jisako.2023.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/23/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Abstract
IMPORTANCE Lisfranc injuries remain a significant, but often misdiagnosed, orthopaedic injury. Alongside the traditional methods of surgical fixation, including arthrodesis and open reduction and internal fixation with screws, suture button fixation is an emerging technique. OBJECTIVES The purpose of this study is to investigate the efficacy of suture button fixation for treatment of Lisfranc injuries through a systematic review. EVIDENCE REVIEW A comprehensive literature review was conducted according to the preferred reporting items for systematic reviews using PubMed, Embase, Web of Science, and Cochrane databases for original, English-language studies observing outcomes of Lisfranc injury until August 19, 2022. The clinical studies with evidence level I-IV and at least a 12 month follow-up after the index surgery were included if they examined quantifiable outcomes of Lisfranc injury treated with suture button. Articles were excluded if they included case reports, systematic reviews, comments, editorials, surveys, animal studies, or biomechanical/cadaveric studies. Variables extracted from text and figures include demographic information, return to sport measures, patient reported outcomes, and complications. FINDINGS Of the 10 studies included, there were 186 total patients with an age range of 13-72. In every study, all patients were able to return to sport or activity with a return time averaging from 10.8 to 25.9 weeks. Postoperative American Orthopaedic Foot and Ankle Society scores ranged from 83.5 to 97.0 while pain Visual Analogue Scale ranged from 0.6 to 2.5. Complications were reported in four studies at a rate of 7.7% including two cases of diastasis, two cases of paraesthesia, one case of button irritation, and one of postoperative degenerative joint disease, with no reported revisions. CONCLUSIONS AND RELEVANCE In our systematic review, suture button fixation shows high levels of patient reported outcomes, return to sport, and stable fixation in isolated Lisfranc injuries. This surgical technique provides a physiologic reduction across the Lisfranc joint and reduces the need for reoperation including removal of hardware. However, further evidence such as large sample size high-quality randomized controlled trials is needed to draw a definitive conclusion regarding the best treatment for Lisfranc injuries. LEVEL OF EVIDENCE Level IV, Systematic Review of Level III and IV studies.
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Affiliation(s)
- Andrew D Lachance
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre, PA, 18840, United States.
| | - Margaret Elizabeth Giro
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre, PA, 18840, United States.
| | - Alexander Edelstein
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre, PA, 18840, United States.
| | - Wonyong Lee
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Sq, Sayre, PA, 18840, United States.
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Denove N, Muriuki MG, Juntavee V, Zmugg S, Dekker R, Havey RM, Kadakia A. Simulated Weightbearing and Articular Injury From Transarticular Screws in a Ligamentous Lisfranc Injury Model. Foot Ankle Int 2023; 44:1044-1050. [PMID: 37497892 DOI: 10.1177/10711007231184231] [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: 07/28/2023]
Abstract
BACKGROUND Transarticular screw fixation is a common surgical treatment for tarsometatarsal ligamentous (Lisfranc) injuries. Iatrogenic damage to articular cartilage from screw placement, however, has been thought to potentially lead to increased risk of tarsometatarsal (TMT) joint arthritis after initial injury. To date, no study has evaluated the effect of weightbearing on articular cartilage after screw fixation. The aim of this study was to create a Lisfranc injury and quantify and compare articular damage due to screw fixation before and after simulated weightbearing. METHODS A ligamentous Lisfranc injury was created in 10 cadaveric specimens and treated with transarticular screws. Specimens were cycled for 1000 cycles at 250 N to simulate 2 weeks of physiologic weightbearing. Rotation and diastasis across the Lisfranc complex were measured. Articular injury as a percentage of total articular surface was measured using digital imaging of the first and second TMT joint before and after simulated weightbearing. Comparisons between articular damage were made and statistical analysis was performed. RESULTS Simulated partial weightbearing increased articular injury 1.44-fold (P < .001). The second metatarsal (M2) showed the greatest increase (1.54-fold, P = .0047), whereas the first (M1) showed the least (1.35-fold, P = .0083). Increases seen at the medial (1.43-fold, P = .0387) and middle cuneiform (1.44-fold, P = .0292) were intermediate between the values seen at M2 and M1. CONCLUSION Articular damage from transarticular screw fixation significantly increased after simulated partial weightbearing. This may increase the risk of arthritis and future morbidity when using transarticular screws for the treatment of ligamentous Lisfranc injuries. CLINICAL RELEVANCE Iatrogenic damage to articular cartilage due to screw fixation of ligamentous Lisfranc injuries may be increased with weightbearing.
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Affiliation(s)
- Nicholas Denove
- Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Muturi G Muriuki
- Musculoskeletal Biomechanics Research Laboratory, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Vongtawan Juntavee
- Department of Orthopedic Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephan Zmugg
- The Permanente Medical Group, Inc, Kaiser Permanente, Oakland, CA, USA
| | | | - Robert M Havey
- Musculoskeletal Biomechanics Research Laboratory, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Anish Kadakia
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Chona DV, Park CN, Kim BI, Lau BC. Clinical and Biomechanical Outcomes of Suture Button Fixation for Ligamentous Lisfranc Injury: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231186387. [PMID: 37538534 PMCID: PMC10395171 DOI: 10.1177/23259671231186387] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/14/2023] [Indexed: 08/05/2023] Open
Abstract
Background Flexible ligamentous fixation has increased in popularity for the treatment of ligamentous Lisfranc injury, but the optimal fixation strategy is unclear. Purpose To review the biomechanical, clinical, and radiographic results of ligamentous Lisfranc injuries treated with flexible fixation. Study Design Systematic review; Level of evidence, 4. Methods A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed/Medline and Google Scholar literature databases were queried for clinical and biomechanical (cadaveric) studies relating to flexible fixation of ligamentous Lisfranc injury. Outcomes of interest included patient-reported outcome scores, clinical/biomechanical results, radiographic alignment, and return to activity. Where appropriate, meta-analysis of the postoperative outcomes was performed. Results Of the 34 initial studies, 14 articles (243 feet) were included in the analysis. In the 11 clinical studies (216 patients), the mean postoperative American Orthopaedic Foot & Ankle Society score was 90.1 (n = 150; 6 studies) and the mean visual analog scale score was 1.5 (n = 137; 5 studies). The rate of return to activity was 100% (n = 35; 5 studies), and 100% of patients maintained radiographic alignment postoperatively (n = 62; 6 studies). No complications or subsequent hardware removals were reported. Of the 3 biomechanical studies (27 feet), 1 study found significantly greater change in diastasis under axial load between intact and postfixation ligaments with suture button versus screw fixation (+1.1 vs -0.1 mm; P < .05), another found no difference in the decrease in diastasis under axial load between the injured state and screw or suture button fixation (1.2 vs 1.0 mm; P = .5), and the third found no difference in displacement between intact and either screw or suture button fixation under either axial (intact vs screw: 1.0 vs 2.0 mm, P = .1; intact vs suture button: 0.6 vs 1.8 mm, P = .1) or abduction (intact vs screw: 1.5 vs 1.1 mm, P = .5; intact vs suture button: 1.3 vs 2.1 mm, P = .1) load. Conclusion Flexible fixation use in the treatment of ligamentous Lisfranc injury was found to have significant potential as a fixation option, as demonstrated by excellent clinical results. Biomechanical evidence was inconclusive but suggested a trend toward decreased diastasis in specimens fixed with screws compared with suture buttons.
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Affiliation(s)
- Deepak V. Chona
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Caroline N. Park
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, North Carolina, USA
| | - Billy I. Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Brian C. Lau
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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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.
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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
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Ahluwalia R, Yip G, Richter M, Maffulli N. Surgical controversies and current concepts in Lisfranc injuries. Br Med Bull 2022; 144:57-75. [PMID: 36151742 DOI: 10.1093/bmb/ldac020] [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: 08/15/2021] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Lisfranc injuries, not as rare as previously reported, range from ligamentous to complex fracture-dislocations. Anatomical studies have identified a complex of discrete structures, and defined the anatomical characteristics of the Lisfranc joint. SOURCES OF DATA A narrative evidence-based review encompassed and analyzed published systematic reviews. Outcomes included clinical and surgical decision-making, including clinical-presentation, diagnosis, pathological-assessment, surgical-management techniques and indications, post-surgical care and comparative outcomes. AREAS OF AGREEMENT Better understanding of the Lisfranc complex anatomy aids surgical treatment and tactics. Prognosis is related to injury severity, estimated by the number of foot columns affected. Surgical outcome is determined by anatomical reduction for most fixation and fusion techniques. Appropriate treatment allows return to sport, improving outcome scores. AREAS OF CONTROVERSY Identification of Lisfranc injuries may be improved by imaging modalities such as weight-bearing computer tomography. Recent evidence supports dorsal plate fixation as a result of better quality of reduction. In complex injuries, the use of combined techniques such as trans-articular screw and plate fixation has been associated with poorer outcomes, and fusion may instead offer greater benefits. GROWING POINTS Open reduction is mandatory if closed reduction fails, highlighting the importance of understanding surgical anatomy. If anatomical reduction is achieved, acute arthrodesis is a safe alternative to open reduction internal fixation in selected patients, as demonstrated by comparable outcomes in subgroup analysis. AREAS FOR DEVELOPING RESEARCH The current controversies in surgical treatment remain around techniques and outcomes, as randomized controlled trials are infrequent.
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Affiliation(s)
- Raju Ahluwalia
- Department of Orthopaedics, King's College Hospital, King's College Hospital NHS Foundation Trust, Bessemer Road, London, SE5 9RS, UK
| | - Grace Yip
- Department of Orthopaedics, King's College Hospital, King's College Hospital NHS Foundation Trust, Bessemer Road, London, SE5 9RS, UK
| | - Martinus Richter
- Department for Foot and Ankle Surgery Nuremberg and Rummelsberg, Hospital Rummelsberg, Rummelsberg 71, Schwarzenbruck 90592, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Salerno, Italy.,Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK
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11
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Guo W, Chen W, Yu J, Wu F, Qian W, Zhuang S, Tian K, Zhuang R, Pan Y. Comparison of flexible fixation and screw fixation for isolated Lisfranc ligament injuries: A protocol for a meta-analysis of comparative studies. Medicine (Baltimore) 2022; 101:e31233. [PMID: 36281088 PMCID: PMC9592458 DOI: 10.1097/md.0000000000031233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The frequency of isolated Lisfranc ligament (ILL) injuries has been increasing recently with the increase in low-energy trauma resulting from sports injuries. For ILL injuries, the optimal method of fixation still remains controversial. The traditional fixation method is achieved by trans-articular screws, but recently, dorsal bridge plates and suture button (SB) fixation have become alternatives. Some biomechanical studies have showed that SB fixation can provide adequate strength compared to trans-articular screws. Therefore, a meta-analysis is imperative to provide evidence on whether flexible fixation is comparable to screw fixation for treatment of ILL injuries. METHODS We will conduct a comprehensive literature search in PubMed, Cochrane Library, EMBASE and Web of Science databases and for comparative studies. We will apply the risk-of-bias tool of the Cochrane Collaboration for Randomized Controlled Trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software (Cochrane Collaboration, London, England). RESULTS This systematic review will evaluate the functional outcomes and radiographic results of flexible fixation for treatment of ILL injuries. CONCLUSION The conclusion of this study will provide evidence for judging whether flexible fixation is superior to screw fixation for treatment of ILL injuries.
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Affiliation(s)
- Wenxuan Guo
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wenhuan Chen
- Third Clinical Medical School, Guangzhou University of Chinese Medicine, District Baiyun, Guangzhou, Guangdong, China
| | - Jinsheng Yu
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fan Wu
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wenqiang Qian
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Siyuan Zhuang
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Kun Tian
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rujie Zhuang
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yu Pan
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- * Correspondence: Yu Pan, Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310003, Zhejiang, ChinaThe First Clinical College, Zhejiang Chinese Medical University, Hangzhou 310003, Zhejiang, China (e-mail: )
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12
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Choi JY, Yu OJ, Suh JS. Factors influencing postoperative residual diastasis after the operative treatment of acute Lisfranc fracture dislocation. Arch Orthop Trauma Surg 2022; 142:2685-2694. [PMID: 34244876 DOI: 10.1007/s00402-021-04058-w] [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] [Received: 05/08/2021] [Accepted: 07/03/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Clinically, surgeons may frequently encounter residual diastasis between the medial cuneiform and 2nd metatarsal base after the operative treatment of acute Lisfranc fracture dislocations. The purpose of this study was to identify factors influencing postoperative residual diastasis. We specifically focused on the preoperative fracture pattern using 3-dimensional computed tomography (3D-CT). MATERIALS AND METHODS Radiographic and clinical findings of 66 patients who underwent operative treatment for acute Lisfranc fracture dislocation were reviewed. Patients were grouped according to residual diastasis evaluated by weight-bearing anteroposterior radiograph of the foot at the final follow-up. Residual diastasis was defined as distance between the medial cuneiform and 2nd metatarsal base greater than the distance on the contralateral side by 2 mm or more. Demographic parameters and fracture patterns based on preoperative foot 3D-CT were compared. A paired t test was used to compare continuous numeric parameters, while a Chi-square test was used for the proportional parameters. Statistical significance was set at P value less than 0.05 for all analyses. RESULTS The mean age at operation, sex, body mass index, and the rate of underlying diabetes were not significantly different between the two groups (P > 0.05 each). Preoperative foot 3D-CT evaluation showed that the rate of large (> 25% of 2nd tarsometatarsal joint involvement), displaced (> 2 mm) fracture fragments on the plantar side of the 2nd metatarsal base was more pronounced in the group with residual diastasis (P = 0.001), while medial wall avulsion of the 2nd metatarsal base was more frequent in the group without residual diastasis (P = 0.001). CONCLUSIONS While treating acute Lisfranc injuries, surgeons should be aware of the presence of a 2nd metatarsal base plantar fracture. A dorsoplantar inter-fragmentary fixation can be considered if the fragment is large and displaced.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Oh Jun Yu
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea.
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13
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Koroneos ZA, Manto KM, Martinazzi BJ, Stauch C, Bifano SM, Kunselman AR, Lewis GS, Aynardi M. Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model. Am J Sports Med 2022; 50:3299-3307. [PMID: 35993448 PMCID: PMC9527447 DOI: 10.1177/03635465221118580] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The preferred method of fixation and surgical treatment for ligamentous Lisfranc injuries is controversial. Transarticular screws, bridge plating, fusion, and flexible fixation have been described, yet none have demonstrated superiority. Furthermore, screw fixation and plating often require secondary surgery to remove implants, leading surgeons to seek alternative fixation methods. PURPOSE To compare transarticular screws and a fiber tape construct under a spectrum of biomechanical loads by evaluating the diastasis at 3 joints in the Lisfranc complex. STUDY DESIGN Controlled laboratory study. METHODS Eight matched pairs of fresh, previously frozen lower extremity cadaveric specimens were fixed with either 2 cannulated transarticular crossed screws or a fiber tape construct with a supplemental intercuneiform limb. The diastasis between bones was measured at 3 midfoot joints in the Lisfranc complex: the Lisfranc articulation, the second tarsometatarsal joint, and the intercuneiform joint. Measurements were obtained for the preinjured, injured, and fixation conditions under static loading at 50% donor body weight. Specimens then underwent cyclic loading performed at 1 Hz and 100 cycles, based on 100-N stepwise increases in ground-reaction force from 100 to 2000 N, to simulate postoperative loading from the partial weightbearing stage to high-energy activities. Failure of fixation was defined as diastasis ≥2 mm at the Lisfranc articulation (second metatarsal-medial cuneiform joint). RESULTS There were no significant differences in diastasis detected at the Lisfranc articulation or the intercuneiform joint throughout all loading cycles between groups. All specimens endured loading up to 50% body weight + 1400 N. Up to and including this stage, there were 2 failures in the cannulated transarticular crossed-screw group and none in the fiber tape group. CONCLUSION The fiber tape construct with a supplemental intercuneiform limb, which does not require later removal, may provide comparable biomechanical stability to cannulated transarticular crossed screws, even at higher loads. CLINICAL RELEVANCE Ligamentous Lisfranc injuries are common among athletes. Therefore, biomechanical evaluations are necessary to determine stable constructs that can limit the time to return to play. This study compares the biomechanical stability of 2 methods of fixation for ligamentous injury through a wide spectrum of loading, including those experienced by athletes.
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Affiliation(s)
- Zachary A. Koroneos
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Kristen M. Manto
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Brandon J. Martinazzi
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Chris Stauch
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Shawn M. Bifano
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Allen R. Kunselman
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Gregory S. Lewis
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Michael Aynardi
- Department for Orthopaedics and Rehabilitation, The Pennsylvania State University, Hershey, Pennsylvania, USA,Michael Aynardi, MD, Center for Orthopaedic Research and Translational Science, The Pennsylvania State University, 500 University Dr, H089 Hershey, PA 17033, USA ()
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14
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Sullivan M, Peckston D, Alpuerto B. Shortening the Return-to-Play Times in Elite Athletes With Unstable Isolated Lisfranc Ligament Injuries Using a Knotless Interosseous Suture Button: Case Series and Literature Review. Orthop J Sports Med 2022; 10:23259671221102969. [PMID: 35757241 PMCID: PMC9218474 DOI: 10.1177/23259671221102969] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Isolated unstable Lisfranc ligament injuries in elite athletes are associated with a lengthy period of rehabilitation and prolonged absence from competition. Purpose: To assess the efficacy of a knotless, interosseous suture button system for repairing isolated unstable ligamentous Lisfranc injuries and its capacity to allow accelerated rehabilitation with earlier weightbearing and return-to-play times in elite athletes. Study Design: Case series; Level of evidence, 4. Methods: The authors retrospectively reviewed data from a prospectively compiled database for elite athletes treated by a single surgeon. All included patients had clinical and magnetic resonance imaging evidence of an unstable isolated complete ligamentous Lisfranc injury requiring surgical reduction and stabilization. All patients underwent surgery using a knotless interosseous suture button to achieve stabilization, followed by a standardized postoperative regimen involving full weightbearing at 4 weeks, and all had a minimum postoperative follow-up of 2 years. Results: Included were 12 patients: 7 National Rugby League (NRL) players, 2 professional dancers, 1 Olympic gymnast, 1 professional wakeboarder, and 1 professional NRL referee. The mean age of the patients was 21.1 years (range, 16-34 years). Ten patients underwent acute surgical stabilization within 3 weeks of the injury, and 2 patients sustained chronic isolated Lisfranc instability that was initially treated nonoperatively. All athletes were able to return to full weightbearing by 4 weeks postoperatively, successfully returned to training by 9 to 12 weeks, and returned to full competition by 12 to 16 weeks. No major complications were reported. Conclusion: Knotless interosseous suture button stabilization was a reliable treatment option for both acute and chronic isolated ligamentous Lisfranc injuries in these elite athletes. This technique does not require hardware removal, allows early weightbearing with accelerated rehabilitation, and may shorten the return-to-play interval.
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Affiliation(s)
- Martin Sullivan
- St. Vincent’s Clinic, Sydney, Australia
- Martin Sullivan, FRACS, FAOrth, St. Vincent’s Clinic, 438 Victoria St, Darlinghurst, NSW 2010, Australia ()
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15
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Paek S, Mo M, Hogue G. Treatment of paediatric Lisfranc injuries: A systematic review and introduction of a novel treatment algorithm. J Child Orthop 2022; 16:198-207. [PMID: 35800659 PMCID: PMC9254024 DOI: 10.1177/18632521221092957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/16/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Pediatric Lisfranc injuries (PLI) are rare injuries that have few studies published about their occurrence and treatment in pediatric population. Due to this lack of information, the diagnostic criteria and surgical or non-surgical methods for treatment have not been clearly established within the pediatric orthopedic literature. The objective of this study was to review the published literature related to treatment options and develop a concise stepwise treatment algorithm for pediatric patients presenting with Lisfranc injuries. METHODS A systematic literature review was conducted using PubMed to find studies discussing the treatment of PLI with reported long-term outcomes. Data collection accounted for the mechanism of injury, diagnostic imaging modality used, injury type, fracture classification using the Myerson system, treatment method used, and postoperative complications. RESULTS An initial PubMed search revealed 290 articles, but only 10 studies fulfilled the criteria for in-depth review. A total of 114 patients were included in this review from the selected case reports and case series studies. Primary treatment methods were as follows: 44% (50/114) with open reduction internal fixation (ORIF) using Kirschner wires (K-wires) and/or screws, 3% (3/114) with closed reduction percutaneous fixation (CRPF), 4% (4/114) with suture-button constructs, 20% (23/114) with cast immobilization, and 29% (33/114) were described as not requiring reduction. CONCLUSION There were two main limitations to this study. First, there are few published studies with longitudinal outcomes of PLI treatment. Second, some case series did not disclose which procedure a patient with post-treatment complications underwent. Therefore, an overall statistical analysis of success and failure rates with associated complications of each procedure could not be conducted. In conclusion, we found that a stepwise approach to evaluating conservative and surgical treatment options based on the presentation of the PLI should be utilized to optimize long-term outcomes.
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Affiliation(s)
- Samuel Paek
- Geisinger Commonwealth School of
Medicine, Scranton, PA, USA,Samuel Paek, Geisinger Commonwealth School
of Medicine, 615 Clay Ave Apt 1, Scranton, PA 18510, USA.
| | - Michelle Mo
- Harvard Medical School, Boston, MA,
USA,Department of Orthopedic Surgery,
Boston Children’s Hospital, Boston, MA, USA
| | - Grant Hogue
- Harvard Medical School, Boston, MA,
USA,Department of Orthopedic Surgery,
Boston Children’s Hospital, Boston, MA, USA
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16
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Koehler L, Waterman BR, Kusnezov NA, Blair JA, Belmont PJ, Orr JD. Occupational Outcomes and Return to Running After Operative Management of Lisfranc Injuries in a High-Demand Population. Foot Ankle Spec 2022; 15:18-26. [PMID: 32517507 DOI: 10.1177/1938640020933078] [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: 11/16/2022]
Abstract
Background: Literature evaluating outcomes following operative fixation of Lisfranc injuries has demonstrated high rates of chronic disability, particularly in those returning to prior levels of physical function. The purpose of this study is to evaluate the occupational outcomes and return to running after open reduction and internal fixation (ORIF) or arthrodesis for Lisfranc fracture-dislocations in a moderate- to high-demand military cohort. Methods: All active-duty servicemembers undergoing ORIF or primary arthrodesis (Current Procedural Terminology 28615 and 28730, respectively) for confirmed Lisfranc fracture-dislocations (International Classification of Diseases, Ninth Revision codes 838.03 or 838.13) with minimum 2-year follow-up were isolated from the Military Health System. Demographic and surgical variables were recorded. Return to military function, return to running, perioperative morbidity, and rates of reoperation for complication were the outcomes of interest. Univariate analysis followed by multivariate logistic regression determined the association between patient demographics, type of fracture fixation (ie, ORIF vs arthrodesis) and functional outcomes, including medical separation. Results: Among Lisfranc injuries, 64 patients underwent ORIF while 6 underwent primary arthrodeses with a mean age of 28.1 years. At mean follow-up of 3.5 years (range, 2.0-6.3 years), 20% of servicemembers underwent medical separation due to limitations related to their injuries. body mass index (BMI) ≥30 kg/m2 (OR 17.67; 95% CI, 3.69-84.53) and Army or Marines service branch (OR 3.86; 95% CI, 1.08-13.86) were significant independent predictors for medical separation. Among servicemembers undergoing ORIF or primary arthrodeses, 69% returned to occupationally required daily running during the follow-up period. Servicemembers with a BMI <30 kg/m2 were more likely to return to running (OR 13.14, 95% CI, 2.50-69.19). Radiographic evidence of posttraumatic Lisfranc osteoarthritis occurred in 10 (16%) servicemembers who underwent internal fixation, and 82% of ORIF patients underwent implant removal. Conclusions: At mean 3.5-year follow-up, 80% of servicemembers undergoing ORIF or primary arthrodeses for Lisfranc injuries remained on active duty or successfully completed their military service, and 69% were able to resume occupationally required daily running. Surgeons should preoperatively counsel patients with these injuries on the possibility of persistent long-term disability.Levels of Evidence: Level IV: Retrospective series.
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Affiliation(s)
- Logan Koehler
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Brian R Waterman
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Nicholas A Kusnezov
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - James A Blair
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Philip J Belmont
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Justin D Orr
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
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17
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Harlow ER, Vakharia AM, Alexeev M, Miskovsky S. Flexible Fixation Technique for Subtle Lisfranc Injuries. VIDEO JOURNAL OF SPORTS MEDICINE 2022; 2:26350254211055197. [PMID: 40309565 PMCID: PMC11897121 DOI: 10.1177/26350254211055197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/04/2021] [Indexed: 05/02/2025]
Abstract
Background Subtle Lisfranc injuries represent a primarily ligamentous Lisfranc complex injury involving the Lisfranc ligament and the medial and middle cuneiform ligaments. Static radiographic displacement or dynamic instability of the medial cuneiform and 2nd metatarsal typically warrants operative intervention to prevent chronic functional pain, allow for timely return-to-sport, and mitigate posttraumatic osteoarthritis. Flexible fixation techniques offer a unique solution to the issues seen with transarticular screws, plates, and arthrodesis for ligamentous Lisfranc injuries. Indications We present the case of a 16-year-old female basketball player with a subtle Lisfranc injury sustained during practice. X-rays show isolated widening of the 1st and 2nd metatarsal bases and dynamic diastasis between the medial and middle cuneiforms. Magnetic resonance imaging (MRI) confirmed a rupture of the plantar Lisfranc ligament. After extensive discussion regarding treatment options, the patient and her family decided to proceed with surgical intervention using a suture anchor and button technique to restore stability to the Lisfranc ligament and intercuneiform complexes. Technique Description A standardized dynamic examination under anesthesia identifies the extent of the injury. Exposure of the base of the 2nd metatarsal and medial cuneiform is performed. Reduction clamps are applied to restore the intercuneiform relationship and interval between the medial cuneiform and base of 2nd metatarsal. The suture anchor and button construct is placed using fluoroscopic guidance. A final dynamic examination is performed to confirm stability of the construct. Results Biomechanical studies have shown that flexible fixation maintains physiologic motion about the Lisfranc articulations and has comparable stability to transarticular screws in cadaveric models of isolated Lisfranc ligament insufficiency. Clinical results are limited but demonstrate excellent postoperative functional outcome scores with very few fixation-related complications at 1 to 3 years. Discussion Flexible fixation techniques for subtle Lisfranc injuries offer unique benefits to transarticular screws, plates, and arthrodesis. We highlight the appropriate evaluation of patients with a suspected subtle ligamentous Lisfranc injury, the surgical technique using a suture button and anchor construct, and review postoperative management and expected outcomes based on the present literature.
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Affiliation(s)
- Ethan R. Harlow
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ajit M. Vakharia
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Mikhail Alexeev
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Shana Miskovsky
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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18
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Garríguez-Pérez D, Puerto-Vázquez M, Tomé Delgado JL, Galeote E, Marco F. Impact of the Subtle Lisfranc Injury on Foot Structure and Function. Foot Ankle Int 2021; 42:1303-1310. [PMID: 34109830 DOI: 10.1177/10711007211012956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The subtle Lisfranc injury is the disruption of the osteoligamentary complex between the first cuneiform and the second metatarsal, resulting in minor widening of this space that is often difficult to detect with plain radiographs. In this study, we assessed the results after treatment of the different stages of subtle Lisfranc injuries, focusing on their impact on foot arch anatomy and functionality at short- to midterm follow-up. METHODS A retrospective study including patients treated in our center for a subtle Lisfranc injury between 2012 and 2019 was conducted. Demographic, epidemiologic, radiographic, and clinical data were obtained and assessed, focusing on foot arch structure and foot function, which was evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score and the Foot Function Index (FFI). RESULTS A total of 42 patients with a mean age of 49 ± 17.5 years were included, with an average of 4.3 years' follow-up (range, 1-8). Stage I injuries according to Nunley classification represented 19% and were treated conservatively. Stage II (66.7%) and stage III (14.3%) injuries were treated operatively, via osteosynthesis with screws (74%), K-wires (19%), or plates (7%). Flattening of foot arch after treatment was observed in 42.9% of patients, with significant increases in Costa-Bertani (12 ± 7 degrees), Hibbs (7 ± 6 degrees), and Meary (3 ± 1 degrees) angles. Other complications included complex regional pain syndrome (28.6%) and painful hardware (23.8%). Secondary joint arthrodesis was needed in 16.6% of patients. Chronic pain was present in 71.4% of patients with a mean visual analog scale (VAS) pain score at final follow-up of 4 of 10 points. Results in AOFAS midfoot score and FFI were 87.4 ± 8.3 and 15 ± 6.4, respectively. CONCLUSION The subtle Lisfranc injury shows dissociation between the initial relatively mild radiographic changes and important future complications. Chronic pain and foot arch flattening were not uncommon. Overall foot function in the short- or midterm was found to be modestly diminished in this somewhat heterogenous cohort. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Daniel Garríguez-Pérez
- Foot and Ankle Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - María Puerto-Vázquez
- Foot and Ankle Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - José Luis Tomé Delgado
- Foot and Ankle Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Enrique Galeote
- Foot and Ankle Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Fernando Marco
- Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
- Department of Surgery, Complutense University, Madrid, Spain
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Chun DI, Kim J, Min TH, Cho J, Won SH, Lee M, Yi Y. Fixation of isolated Lisfranc ligament injury with the TightRope™: A technical report. Orthop Traumatol Surg Res 2021; 107:102940. [PMID: 33895381 DOI: 10.1016/j.otsr.2021.102940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 01/08/2021] [Accepted: 01/21/2021] [Indexed: 02/03/2023]
Abstract
Treatment of Lisfranc ligament injury is still debatable. For this reason, we applied a standard suture button (TightRope™, Arthrex, Naples, FL), a device originally designed for syndesmosis fixation, in treating isolated Lisfranc ligament (ILL) injuries. Twelve patients diagnosed as having an ILL injury were recruited. All patients regained their previous activity level within 3 months after the surgery without any complications. We propose that standard suture button device in an ILL injury is an easy technique to perform with short learning curve, accompanied with satisfactory outcomes.
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Affiliation(s)
- Dong-Il Chun
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, 657-52 Hannam-dong Yong-San Gu, Seoul, Republic of Korea
| | - Jahyung Kim
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, 657-52 Hannam-dong Yong-San Gu, Seoul, Republic of Korea
| | - Tae-Hong Min
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, 657-52 Hannam-dong Yong-San Gu, Seoul, Republic of Korea
| | - Jaeho Cho
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, College of Medicine. 77, SakJu-Ro, Gyo-dong, 24262 Chun-Cheon, Republic of Korea
| | - Sung Hun Won
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, 657-52 Hannam-dong Yong-San Gu, Seoul, Republic of Korea
| | - Minki Lee
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, 85, 2-ga, Jeo-dong, Jung-gu, 100-032 Seoul, Republic of Korea
| | - Young Yi
- Department of Orthopedic Surgery, Seoul Paik Hospital, Inje University, 85, 2-ga, Jeo-dong, Jung-gu, 100-032 Seoul, Republic of Korea.
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20
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Chen J, Sagoo N, Panchbhavi VK. The Lisfranc Injury: A Literature Review of Anatomy, Etiology, Evaluation, and Management. Foot Ankle Spec 2021; 14:458-467. [PMID: 32819164 DOI: 10.1177/1938640020950133] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite being first described in the 1800s, the Lisfranc injury remains one of the most controversial topics in foot and ankle surgery. From the basic anatomy of the ligament complex to the optimal diagnostic and management methods, new research both sharpens and yet confounds our understanding of this unique injury. This article reviews the literature from established and classic papers to recent studies evaluating newer techniques. We discuss the unique bony and ligamentous anatomy, which confer strength to the Lisfranc complex, the typical mechanisms of injury, the most common classification systems, the clinical presentation, current imaging modalities, and conservative and surgical treatment options. We review studies comparing open reduction and internal fixation with primary arthrodesis of acute injuries, in addition to studies evaluating the various methods for obtaining fixation, including intra-articular screws, dorsal plates, and flexible fixation. It is clear from this review that despite the vast number of studies in the literature, much is still to be learned about the diagnosis and management of this challenging injury.Levels of Evidence: Level V: Expert opinion.
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Affiliation(s)
- Jie Chen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, NS, VKP)
| | - Navraj Sagoo
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, NS, VKP)
| | - Vinod Kumar Panchbhavi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, NS, VKP)
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21
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Abstract
Background. Injury to the Lisfranc interosseous ligament is currently managed with a screw. However, this can potentially further disrupt the ligament. The objective of this study was to observe the proximity of the screw or disruption it can cause at the ligament attachment sites. Methods. Twenty-three feet were studied. A 40-mm, 4.0, partially threaded, cannulated screw was inserted from the base of the second metatarsal into the medial cuneiform. The relationship of the ligament attachment sites to the screw hole were measured. Results. The screw hole contacted at least 1 of the ligament attachment sites in 20 of the 23 feet. The screw hole fully penetrated it in 7 feet, partially disrupted it in 4 feet, and had less than or equal to 1 mm of contact in 9 feet. There was no contact with either of the attachment sites in 3 feet, with an average distance of 1.5 mm separating them. Conclusion. Our results show the proximity of the ligament to the screw and the disruption that can result from its insertion. This is clinically relevant as some amount ligamentous disruption is likely to occur with insertion of the "Lisfranc screw," which may interfere with its healing process.Levels of Evidence: Level V: Expert opinion includes case reports and technique tips.
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Affiliation(s)
- Stephen Sierra
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
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22
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Cottom JM, Graney CT, Sisovsky C. Treatment of Lisfranc Injuries Using Interosseous Suture Button: A Retrospective Review of 84 Cases With a Minimum 3-Year Follow-Up. J Foot Ankle Surg 2021; 59:1139-1143. [PMID: 32830017 DOI: 10.1053/j.jfas.2019.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/30/2019] [Accepted: 12/26/2019] [Indexed: 02/03/2023]
Abstract
Lisfranc fracture dislocation is an injury often encountered by the foot and ankle surgeon. This injury, depending on the severity and level of energy, has been shown to lead to posttraumatic osteoarthritis and chronic pain if undiagnosed or improperly managed. The purpose of this study was to retrospectively evaluate the surgical repair with the use of an interosseous suture button for Lisfranc injuries with isolated ligamentous disruption. From 2008 through 2016, 104 patients were consecutively enrolled who underwent open reduction internal fixation (ORIF) of the Lisfranc complex with a suture button and stabilization of the medial and intermediate cuneiform with a 4.0-mm screw. Eighty-four patients were available for a 3-year minimum follow-up. The mean return to full weightbearing was 11 days protected in a controlled ankle motion (CAM) boot. American Orthopedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scores improved from 30 and 8.4, respectfully, preoperatively to 90 and 1.3 postoperatively. The mean preoperative step-off between the second metatarsal base and intermediate cuneiform was found to be 3.15 mm. The immediate postreduction weightbearing radiograph measured 0.25 mm and 0.43 mm at the final follow-up evaluation, a difference that was found to be significant. There were no revision arthrodeses performed and no removal of the suture button during this time period. ORIF using an interosseous suture button appears to have an adequate medium-term patient satisfaction; however, there is evidence of minimal diastasis in some patients at 3 years postoperatively in ligamentous Lisfranc fracture dislocations.
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Affiliation(s)
- James M Cottom
- Fellowship Trained Foot and Ankle Surgeon and Director, Florida Orthopedic Foot & Ankle Center Fellowship, Sarasota, FL.
| | - Colin T Graney
- Fellow, Florida Orthopedic Foot & Ankle Center Fellowship, Sarasota, FL
| | - Charles Sisovsky
- Fellow, Florida Orthopedic Foot & Ankle Center Fellowship, Sarasota, FL
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Park YH, Ahn JH, Choi GW, Kim HJ. Percutaneous Reduction and 2.7-mm Cortical Screw Fixation for Low-Energy Lisfranc Injuries. J Foot Ankle Surg 2021; 59:914-918. [PMID: 32345510 DOI: 10.1053/j.jfas.2019.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/24/2019] [Accepted: 10/03/2019] [Indexed: 02/03/2023]
Abstract
To use the advantages of transarticular screw fixation while minimizing iatrogenic involved joint damage and screw irritation, it is important to determine the screw size. The aim of this study was to analyze the outcomes of percutaneous reduction and 2.7-mm cortical screw fixation for low-energy Lisfranc injuries and determine whether the procedure is a safe alternative to traditional screw fixation using a larger screw size. A review was performed for all patients who underwent percutaneous reduction and 2.7-mm cortical screw fixation for low-energy Lisfranc injuries at a single institution over a 6-year period. Thirty-one patients were enrolled in this study. Patients were assessed clinically and radiographically for demographics, foot function index (FFI), numerical rating scale (NRS) for pain, patient satisfaction, and complication rates. Factors affecting screw breakage and its clinical relevance were also analyzed. The FFI and NRS for pain were 17.2 ± 14.7 (range 0.8 to 57.8) and 3.1 ± 2.3 (range 0 to 8) points, respectively, at the 12-month follow-up visit. One patient (3.2%) underwent arthrodesis for the development of posttraumatic arthritis; all other patients recovered without sequelae. Screw breakage was identified in 7 patients (22.6%). There was no significant difference between patients with and without screw breakage in terms of FFI, NRS for pain, patient satisfaction, or complication rate. Body mass index (BMI) was significantly higher in patients with screw breakage than in those without screw breakage. Receiver operator characteristics curve analysis demonstrated a strong relationship between BMI and screw breakage (area under the curve = 90%, p < .001), and the potential BMI cutoff value was 27.8 kg/m2. After considering the incidence of screw breakage, percutaneous reduction and 2.7-mm cortical screw fixation can be a viable option for treating low-energy Lisfranc injuries in nonobese patients, especially those with BMI <27.8 kg/m2.
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Affiliation(s)
- Young Hwan Park
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jeong Hwan Ahn
- Orthopaedic Resident, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Gi Won Choi
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Hak Jun Kim
- Professor and Orthopaedic Surgeon, Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Korea.
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Mosca M, Fuiano M, Censoni D, Marcheggiani Muccioli GM, Roberti di Sarsina T, Grassi A, Caravelli S, Zaffagnini S. A mid-term follow-up retrospective evaluation of tarsometatarsal joint fracture-dislocations treated by closed reduction and percutaneous K-wires fixation. Injury 2021; 52:1635-1640. [PMID: 33070946 DOI: 10.1016/j.injury.2020.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/22/2020] [Accepted: 10/07/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Injuries involving the tarsometatarsal (TMT) joint are relatively uncommon, and the surgical treatment is potentially characterized by a high complications rate. The purpose of this study is to evaluate the results of the treatment of Lisfranc fracture-dislocations treated with closed reduction and percutaneous fixation with K-wires, considering complications and re-intervantion rate. MATERIALS AND METHODS A retrospective review was performed on all patients undergone closed reduction and percutaneous fixation with K-wires of a Lisfranc fracture-dislocation. Patients have been clinically evaluated at last follow up by American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and Visual Analogue Scale (VAS), as well as by radiograph assessment. RESULTS Following inclusion and exclusion criteria, 15 patients have been included, with a mean age of 48.2 ± 5.6 years. Average follow-up was 3.8 ± 1.8 years (range 1-6). 7 fractures analyzed were classified as type A, 7 as type B (3 were B1, 4 were B2) and 1 as type C1. No case of loss of reduction has been observed at radiographic 1-month follow-up. At last follow-up mean AOFAS midfoot score and VAS score were respectively 82.2 ± 10.4 and 1.5 ± 1.3. Registered complications showed one deep vein thrombosis and 2 cases of complex regional pain syndrome (CRPS). One patient subsequently underwent arthrodesis of the tarsometatarsal joint for post-traumatic arthritis. CONCLUSIONS The treatment of the fracture-dislocations of the Lisfranc joint by percutaneous reduction and fixation with K-wire can achieve good clinical outcomes with a low rate of complications and reoperations. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Censoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulio Maria Marcheggiani Muccioli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Dipartimento Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna-Alma Mater Studiorum, Bologna, Italy
| | | | - Alberto Grassi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Stefano Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Dipartimento Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna-Alma Mater Studiorum, Bologna, Italy
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Cardile C, Cazzaniga C, Manzini B, Marasco R, Ragni P. Lisfranc injuries in adolescents: A case report and literature review. Foot (Edinb) 2021; 47:101812. [PMID: 33957527 DOI: 10.1016/j.foot.2021.101812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
Lisfranc injuries result if bones or ligaments that support the midfoot are torn. In children and adolescents these injuries are not only rare, but are also similar to adult Lisfranc injuries, in that they are often mistaken especially if the injury is a result of a straightforward twist and fall. The goal of surgical treatment is to realign the joints. However, few studies related to Lisfranc injuries in pediatric patients exist. A case of 15 years old patient treated using an Arthrex mini tight rope is described.
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Affiliation(s)
- Carlo Cardile
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, viale Forlanini 95, 20024 Garbagnate Milanese, Milano, Italy.
| | - Carlo Cazzaniga
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, viale Forlanini 95, 20024 Garbagnate Milanese, Milano, Italy
| | - Beatrice Manzini
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, viale Forlanini 95, 20024 Garbagnate Milanese, Milano, Italy
| | - Roberto Marasco
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, viale Forlanini 95, 20024 Garbagnate Milanese, Milano, Italy
| | - Paolo Ragni
- Section of Orthopedics and Trauma Surgery, Ospedale Salvini, viale Forlanini 95, 20024 Garbagnate Milanese, Milano, Italy
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Cho J, Kim J, Min TH, Chun DI, Won SH, Park S, Yi Y. Suture Button vs Conventional Screw Fixation for Isolated Lisfranc Ligament Injuries. Foot Ankle Int 2021; 42:598-608. [PMID: 33349047 DOI: 10.1177/1071100720976074] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Suture buttons have been used for isolated Lisfranc ligament (ILL) fixation. However, no study has reported on its clinical and radiologic outcomes. METHODS In this retrospective comparative study, patients with ILL injuries were divided into 2 groups according to the treatment method: 32 conventional screw group and 31 suture button group. The clinical and radiologic outcomes at preoperation, 6 months and 1 year postoperation, and last follow-up period were measured. Plantar foot pressure was measured at postoperative month 6 months. Postoperative complications at the last follow-up were evaluated. RESULTS The suture button group showed better American Orthopaedic Foot & Ankle Society midfoot scale (P < .001) and visual analog scale (P < .001) scores compared with the conventional screw fixation group at the postoperative month 6 period before screw removal. However, no significant difference in clinical outcome between the 2 groups was found at postoperative year 1 or last follow-up. No differences in radiologic outcomes were found between the 2 groups. Plantar foot pressure was significantly elevated in the conventional screw group at the great toe and first metatarsal head area compared with the contralateral foot just before screw removal. Recurrent Lisfranc joint diastasis was found in a single case in the conventional screw group and 2 cases in the suture button group. CONCLUSION Suture button fixation in the treatment of ILL injuries may provide comparable fixation stability and clinical outcome with conventional screw fixation in the early postoperative period. LEVEL OF EVIDENCE Level III, retrospective case-control study, therapeutic.
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Affiliation(s)
- Jaeho Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Gangwon-do, Korea
| | - Jahyung Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Tae-Hong Min
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Dong-Il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Hospital, College of Medicine, Seoul, Republic of Korea
| | - Young Yi
- Department of Orthopaedic Surgery, Seoul Foot and Ankle Center, Inje University Seoul Paik Hospital, Seoul, Korea
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Koroneos Z, Vannatta E, Kim M, Cowman T, Fritsche M, Kunselman AR, Lewis GS, Aynardi M. Biomechanical Comparison of Fibertape Device Repair Techniques of Ligamentous Lisfranc Injury in a Cadaveric Model. Injury 2021; 52:692-698. [PMID: 33745699 DOI: 10.1016/j.injury.2021.02.077] [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: 12/22/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lisfranc ligamentous injuries are complex, and their treatment, along with the preferred method of fixation, is controversial. Implementing a flexible synthetic augmentation device (fibertape) has been described as an alternative to traditional screw fixation. This biomechanical study evaluated two fibertape devices with interference screw fixation: InternalBrace, and InternalBrace with supplementary intercuneiform stabilization. METHODS The diastasis and relative angular displacement between bones were measured at three midfoot joints in the Lisfranc articulation. Measurements were obtained for the pre-injured, injured, and post-fixation stages under static loading. Specimens then underwent stepwise increases in cyclic loading performed at 1 Hz and 100 cycles, at 100 N ground reaction force intervals from 500 to 1200 N to simulate postoperative loading, and then up to 1800 N to simulate high loads. Failure of fixation was defined as diastasis greater than 2 millimeters at the second-metatarsal - medial-cuneiform joint. RESULTS InternalBrace specimens demonstrated failures in 3 of 9 (33%) specimens at cyclic loads of 1000 N. Conversely, InternalBrace with Supplementary Limb specimens had 1 failure at 1200 N. The difference in diastasis at the second metatarsal-medial cuneiform joint was statistically significant between the two groups at higher loads of 1600N (p = 0.019) and 1800N (p = 0.029). CONCLUSION The use of InternalBrace for ligamentous Lisfranc injuries appears to provide a biomechanically viable alternative for withstanding early postoperative protected weight bearing. Furthermore, the use of a supplementary limb in addition to the InternalBrace fibertape fixation method appears to enhance its biomechanical efficacy.
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Affiliation(s)
- Zachary Koroneos
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
| | - Emily Vannatta
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
| | - Morgan Kim
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
| | - Trevin Cowman
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
| | - Madelaine Fritsche
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
| | - Allen R Kunselman
- The Pennsylvania State University, Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, 500 University Drive, H089 Hershey, PA, 17033.
| | - Gregory S Lewis
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
| | - Michael Aynardi
- The Pennsylvania State University, Center for Orthopaedic Research and Translational Science, 500 University Drive, H089 Hershey, PA, 17033.
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Sports-Related Lisfranc Injuries and Recognition of Lisfranc Variants: Surgical Strategies for Stabilization. Foot Ankle Clin 2021; 26:13-33. [PMID: 33487236 DOI: 10.1016/j.fcl.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Much has changed since Lisfranc described lesions at the tarsometatarsal (TMT) joint in 1815. What was considered an osseous high-energy condition nowadays is understood as myriad possible presentations, occurring in minor and inconspicuous traumas. Advancements in diagnostics of Lisfranc injury allow recognizing many variants of this trauma presentation, most of them with a focus on ligaments. This perception shifted trends in surgical planning, especially for implants and fixation techniques. These revolutions established a new and evolving universe around TMT lesions, different from what was known only a few years ago and still not enough to completely settle the disease scenario.
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Kushare I, Wunderlich N, Elabd A, Attia E. Pediatric and adolescent Lisfranc injuries - Presentation, treatment and outcomes. Foot (Edinb) 2021; 46:101737. [PMID: 33853714 DOI: 10.1016/j.foot.2020.101737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/03/2020] [Accepted: 08/29/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Lisfranc fracture dislocations are rare injuries and even more so in the pediatric population. The main purpose of our study is to present a descriptive analysis of Lisfranc injuries in pediatric patients to add to the current sparse literature on this topic. In addition, our secondary outcome was to analyze any differences in patients treated conservatively versus operatively, and those with isolated Lisfranc injuries versus those with associated foot injuries. METHODS Charts of patients with Lisfranc injury treated at a tertiary pediatric hospital from January 2010 to July 2019 were reviewed to analyze their demographics, injury characteristics, management details and rehabilitation protocol. Functional outcome was assessed using the Visual Analogue Scale of Pain (VAS) and the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). RESULTS 30 patients/cases were included with mean age of 13.6 years and mean follow up of 36 weeks. 20% of the cases were missed on initial presentation. 19 cases were managed operatively while 11 were managed conservatively. The average OxAFQ-C and VAS pain scores were 83% and 1.3, respectively at mean follow-up of 36 weeks. The functional outcomes between conservative and operative cases or between those with isolated Lisfranc injuries and those with associated foot injuries were not statistically significant (p > 0.05). CONCLUSION Lisfranc injury in pediatrics can be easily missed. High index of suspicion, a thorough clinical examination and the use of advanced imaging is warranted. Various modalities like K-wires, screws and suture-buttons can be used for fixation. Early to mid-term functional outcomes are satisfactory provided that adequate reduction is obtained.
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Affiliation(s)
- Indranil Kushare
- Texas Children's Hospital, 6701 Fannin St., Houston, TX 77030, USA; Department of Orthopedic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
| | - Nicole Wunderlich
- Texas Children's Hospital, 6701 Fannin St., Houston, TX 77030, USA; Department of Orthopedic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Ahmed Elabd
- Texas Children's Hospital, 6701 Fannin St., Houston, TX 77030, USA; Department of Orthopedic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Elsayed Attia
- Texas Children's Hospital, 6701 Fannin St., Houston, TX 77030, USA; Department of Orthopedic Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
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Yan A, Chen SR, Ma X, Shi Z, Hogan M. Updates on Lisfranc Complex Injuries. FOOT & ANKLE ORTHOPAEDICS 2021; 6:2473011420982275. [PMID: 35097425 PMCID: PMC8702936 DOI: 10.1177/2473011420982275] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Lisfranc injuries are a disruption of one or more of the tarsometatarsal joints and have an estimated incidence of 1/55 000 people. However, the total number of Lisfranc injuries could be underreported, because almost 20% of these injuries are initially missed. Because of the relative infrequency of these injuries, the current literature is inconsistent in regard to proper treatment. This article provides a review of Lisfranc complex injuries including relevant anatomy, diagnosis, treatment, classifications, operative approaches, and outcomes and complications. Based on existing evidence, it also proposes an algorithm the authors prefer for the evaluation and treatment of Lisfranc complex injuries.
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Affiliation(s)
- Alan Yan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- The Foot and Ankle Injury Research (FAIR) Group, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen R. Chen
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- The Foot and Ankle Injury Research (FAIR) Group, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhongmin Shi
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - MaCalus Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- The Foot and Ankle Injury Research (FAIR) Group, University of Pittsburgh, Pittsburgh, PA, USA
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Philpott A, Epstein DJ, Lau SC, Mnatzaganian G, Pang J. Lisfranc Fixation Techniques and Postoperative Functional Outcomes: A Systematic Review. J Foot Ankle Surg 2021; 60:102-108. [PMID: 33039319 DOI: 10.1053/j.jfas.2020.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/10/2019] [Accepted: 04/07/2020] [Indexed: 02/03/2023]
Abstract
The optimal method of fixation of acute Lisfranc injuries is yet to be established. We aim to systematically review the literature to identify the impact of fixation method on postoperative functional outcomes. A systematic review was undertaken using the PRISMA framework to identify all studies reporting postoperative functional outcomes in patients who underwent open-reduction internal fixation of acute Lisfranc injuries. Studies reporting outcomes of numerous fixation methods were divided into fixation subcohorts. Studies comparing bridge plate with transarticular screw fixation were included for meta-analysis, conducted using a random-effects model. Seventeen studies (20 subcohorts) with 462 patients were included. Mean patient age was 29.6 (rang, 15-81) years. Mean follow-up was 38.7 (range 11 to 287) months. American Academy of Orthopaedic Surgeons midfoot score (AOFAS-MF) was the most frequently reported functional outcome (16/20 subcohorts). Overall weighted mean AOFAS-MF was 76.3 ± 9.4 for all cases, with 74.2 ± 9.4 for transarticular screws and 79.2 ± 8.3 for bridge plates. The mean difference between screw and plate was not statistically significant (mean difference = 5.0, 95% confidence interval, -4.8 - 14.8, p = .3). A single study reported AOFAS-MF mean of 92 using suture button fixation. Meta-analysis of the 2 available comparative studies revealed higher postoperative AOFAS-MF with bridge plate fixation (pooled standardized mean difference, 0.51; 95% confidence interval, 0.15-0.87, p = .006). There is scarcity of literature examining the impact of fixation method on postoperative functional outcomes in acute Lisfranc injuries. A small number of studies have reported superior functional outcomes with use of bridge plate fixation. Further evidence is needed to ascertain which injuries are best managed with each fixation method or whether 1 fixation construct is universally superior.
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Affiliation(s)
- Andrew Philpott
- Orthopaedic Registrar, Bendigo Base Hospital, Bendigo, Victoria, Australia.
| | - Daniel J Epstein
- Orthopaedic Registrar, Bendigo Base Hospital, Bendigo, Victoria, Australia
| | - Simon C Lau
- Orthopaedic Registrar, Royal Melbourne Hospital, Victoria, Australia
| | - George Mnatzaganian
- Statistician, La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Victoria, Australia
| | - Jack Pang
- Consultant Orthopaedic Surgeon, Bendigo Base Hospital, Bendigo, Victoria, Australia
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Allahabadi S, Amendola A, Lau BC. Optimizing Return to Play for Common and Controversial Foot and Ankle Sports Injuries. JBJS Rev 2020; 8:e20.00067. [PMID: 33405494 DOI: 10.2106/jbjs.rvw.20.00067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
» Surgical decision-making should consider factors to help optimize return to play for athletes with foot and ankle injuries, including injuries to the syndesmosis, the Achilles tendon, the fifth metatarsal, and the Lisfranc complex. Understanding influential factors on return to play may help orthopaedic surgeons counsel athletes and coaches on expectations for a timeline to return to play and performance metrics. » Outcomes after rigid and flexible fixation for syndesmotic injuries are generally favorable. Some data support an earlier return to sport and higher functional scores with flexible fixation, in addition to lower rates of reoperation and a decreased incidence of malreduction, particularly with deltoid repair, if indicated. » Minimally invasive techniques for Achilles tendon repair have been shown to have a decreased risk of wound complications. Athletes undergoing Achilles repair should expect to miss a full season of play to recover. » Athletes with fifth metatarsal fractures have better return-to-play outcomes with surgical management and can expect a high return-to-play rate within approximately 3 months of surgery. » Percutaneous treatment of Lisfranc injuries may expedite return to play relative to open procedures.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Annunziato Amendola
- Duke Sport Science Institute, Division of Sports Medicine, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Brian C Lau
- Duke Sport Science Institute, Division of Sports Medicine, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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Abstract
The management of Lisfranc injuries is challenging considering the broad spectrum of energy involved and highly variable clinical presentation. Despite the advances in surgical techniques, subtle Lisfranc injuries can lead to chronic pain and permanent disability. Surgical treatment is mandatory for all the unstable injuries; however, the best surgical technique remains controversial. The most predictive factor for a successful outcome is the maintenance of anatomic alignment; therefore, the selection of the appropriate surgical technique is of paramount importance. This article reviews the current treatment options and describes the selection of the surgical technique based on the different clinical presentations.
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Affiliation(s)
- Jorge Briceno
- Department of Orthopedic Surgery, Pontificia Universidad Catolica de Chile. Diagonal Paraguay 362, Postal code: 8330077, Santiago, Región Metropolitana, Chile
| | - Anna-Kathrin Leucht
- Department of Orthopaedics and Traumatology, Cantonal Hospital of Winterthur, Buchnerstrasse 1, 8006 Zurich, Switzerland
| | - Alastair Younger
- Department of Orthopaedics, Division of Distal Extremities, University of British Columbia, Vancouver, British Columbia, Canada; Department of Orthopedics, St. Paul's Hospital, UBC, Vancouver, Canada; Footbridge Centre for Integrated Orthopaedic Care Inc., Footbridge Clinic, 221-181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, Division of Distal Extremities, University of British Columbia, Vancouver, British Columbia, Canada; Department of Orthopedics, St. Paul's Hospital, UBC, Vancouver, Canada; Footbridge Centre for Integrated Orthopaedic Care Inc., Footbridge Clinic, 221-181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada.
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Abarquero-Diezhandino A, Ferrero-Recasens J, Vacas-Sanchez E, Mellado-Romero M, Sánchez-Morata E, Vila-Rico J. Study of the functional results of the percutaneous surgical treatment of subtle injuries of the tarso-metatarsian complex. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abarquero-Diezhandino A, Ferrero-Recasens J, Vacas-Sánchez E, Mellado-Romero MA, Sánchez-Morata EJ, Vilá-Rico J. Study of the functional results of the percutaneous surgical treatment of subtle injuries of the tarso-metatarsian complex. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:367-374. [PMID: 32798164 DOI: 10.1016/j.recot.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 06/21/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The concept subtle Lisfranc defines low energy lesions of the tarsometatarsal joint complex (TMC) that involve joint instability. Often unnoticed, with long-term sequelae. The objective is to evaluate the clinical-functional results of patients with MTC ligament damage grade II-III (Nunley and Vertullo classification) treated with percutaneous surgery. MATERIAL AND METHODS Retrospective study of 16 patients who underwent percutaneous surgery for MLC ligament damage. Demographic data, days of delay in diagnosis, surgical technique, joint reduction in load (adequate if C1-M2 space is less than 2 mm) and Manchester-Oxford scale (MOXFQ) score were collected. The sample consisted of nine males and seven females, mean age 43.6 years (17-71) and mean follow-up of 22 months (12-28). RESULTS Diagnosis was delayed for more than 24 hours in four patients (3-6 days). In 11 patients the treatment consisted of closed reduction and percutaneous synthesis with cannulated screws from M2 to C1 and from C1 to C2. In three patients it was supplemented with Kirschner wires in the lateral radii. Two patients were treated with only M2 to C1 screws. An anatomical reduction was not achieved in six patients, with a mean of 2.6 mm between C1-M2 (2.1-3 mm); the mean functional MOXFQ score of these patients was 41.1% (IC 95% 23.1-59.1%), worse results compared to the anatomical reduction: 17.2% (IC 95% 5.7-28.7); statistically significant difference (p < 0.01). CONCLUSION Subtle injuries from MTC are rare and can go unnoticed. Surgical treatment with percutaneous synthesis offers good clinical-functional results in the medium term. The anatomical reduction is a determining factor for the good functional result of our patients.
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Affiliation(s)
| | | | - E Vacas-Sánchez
- Hospital Universitario 12 de Octubre, Madrid, España; Complejo Hospitalario Ruber Juan Bravo. Grupo Quirón Salud, Madrid, España
| | | | | | - J Vilá-Rico
- Hospital Universitario 12 de Octubre, Madrid, España; Universidad Complutense de Madrid, Madrid, España; Complejo Hospitalario Ruber Juan Bravo. Grupo Quirón Salud, Madrid, España
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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: 0.2] [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.
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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.
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Nery C, Baumfeld D, Baumfeld T, Prado M, Giza E, Wagner P, Wagner E. Comparison of Suture-Augmented Ligamentplasty to Transarticular Screws in a Lisfranc Cadaveric Model. Foot Ankle Int 2020; 41:735-743. [PMID: 32116015 DOI: 10.1177/1071100720907878] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lisfranc injuries represent a spectrum of trauma from high-energy lesions, with significant instability of the midfoot, to low-energy lesions, with subtle subluxations or instability without gross displacement. Recently, treatment options that allow for physiologic fixation of this multiplanar joint are being evaluated. The purpose of this study was to analyze the stability of a cadaveric Lisfranc injury model fixed with a novel suture-augmented neoligamentplasty in comparison with a traditional transarticular screw fixation construct. METHODS Twenty-four fresh-frozen, matched cadaveric leg and foot specimens (12 individuals younger than 65 years of age) were used for this study. Two different types of Lisfranc ligament injuries were tested: partial and complete. Two different methods of fixation were compared: transarticular screws and augmented suture ligamentplasty with FiberTape. Specimens were fixed to a rotation platform in order to stress the joints while applying 400 N of axial load and internal and external rotation. Six distances were measured and compared between the intact, injured, and fixed states with a 3D Digitizer arm, in order to evaluate the stability between them. Analysis of variance was used with P < .05 considered significant. RESULTS Using distribution graphs and analyzing the grouped data, it was observed that there was no difference between the 2 stabilization methods, but the augmented suture ligamentplasty presented lower variability and observed distance shortenings were more likely to be around the mean. The variability of the stabilization with screws was 2.9 times higher than that with tape (P < .001). CONCLUSION We suggest that augmented suture ligamentplasty can achieve similar stability to classic transarticular screws, with less variability. CLINICAL RELEVANCE This cadaveric study adds new information on the debate about Lisfranc lesions treatment. Flexible fixations, such as the synthethic ligamentplasty used, can restore good stability such as conventional transarticular screws.
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Affiliation(s)
- Caio Nery
- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Daniel Baumfeld
- Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais (MG), Brazil
| | - Tiago Baumfeld
- Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais (MG), Brazil
| | | | - Eric Giza
- University of California, Davis, Sacramento, CA, USA
| | - Pablo Wagner
- Clinica Alemana de Santiago-Universidad del Desarrollo, Santiago Metropolitan Region (RM), Chile
| | - Emilio Wagner
- Clinica Alemana de Santiago-Universidad del Desarrollo, Santiago Metropolitan Region (RM), Chile
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Wagner E, Wagner P, Baumfeld T, Prado MP, Baumfeld D, Nery C. Biomechanical Evaluation With a Novel Cadaveric Model Using Supination and Pronation Testing of a Lisfranc Ligament Injury. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011419898265. [PMID: 35097361 PMCID: PMC8697228 DOI: 10.1177/2473011419898265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Lisfranc joint injuries can be due to direct or indirect trauma and while the precise mechanisms are unknown, twisting or axial force through the foot is a suspected contributor. Cadaveric models are a useful way to evaluate injury patterns and models of fixation, but a frequent limitation is the amount of joint displacement after injury. The purpose of this study was to test a cadaveric model that includes axial load, foot plantarflexion and pronation-supination motion, which could re-create bone diastasis similar to what is seen in subtle Lisfranc injuries. Our hypothesis was that applying pronation and supination motion to a cadaveric model would produce reliable and measurable bone displacements. Methods: Twenty-four fresh-frozen lower leg cadaveric specimens were used. The medial (C1) and intermediate (C2) cuneiforms and the first (M1) and second (M2) metatarsal bones were marked. A complete ligament injury was performed between C1-C2 and C1-M2 in 12 specimens (group 1), and between C1-C2, C1-M2, C1-M1, and C2-M2 in 12 matched specimens (group 2). Foot pronation and supination in addition to an axial load of 400 N was applied to the specimens. A 3D digitizer was used to measure bone distances. Results: After ligament injury, distances changed as follows: C1-C2 increased 3 mm (23%) with supination; C1-M2 increased 4 mm (21%) with pronation (no differences between groups). As expected, distances between C1-M1 and C2-M2 only changed in group 2, increasing 3 mm (14%) and 2 mm (16%), respectively (no differences between pronation and supination). M1-M2 and C2-M1 distances did not reach significant difference for any condition. Conclusions: Pronation or supination in addition to axial load produced measurable bone displacements in a cadaveric model of Lisfranc injury using sectioned ligaments. Distances M1-M2 and C2-M1 were not reliable to detect injury in this model. Clinical Relevance: This new cadaveric Lisfranc model included foot pronation-supination in addition to axial load delivering measurable bone diastasis. It was a reliable Lisfranc cadaveric model that could be used to test different Lisfranc reconstructions.
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Affiliation(s)
- Emilio Wagner
- Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Pablo Wagner
- Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
- Hospital militar de Santiago, Universidad de los Andes, Santiago, Chile
| | - Tiago Baumfeld
- Hospital Felício Rocho, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Caio Nery
- Federal University of São Paulo, Sao Paulo, Brazil
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Flexible fixation for ligamentous lisfranc injuries. Injury 2019; 50:2123-2127. [PMID: 31378546 DOI: 10.1016/j.injury.2019.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/05/2019] [Accepted: 07/21/2019] [Indexed: 02/02/2023]
Abstract
Lisfranc injuries require anatomic reduction and stabilization of the tarsometatarsal joints. We describe a novel technique that provides flexible fixation that is simple, cost-effective and that may offer certain advantages over more traditional techniques.
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Abstract
Injuries to the Lisfranc complex range from purely ligamentous disruptions to fracture-dislocations of the tarsometatarsal joint. Treatment options include closed/open reduction with percutaneous pinning, open reduction and internal fixation (ORIF), and primary arthrodesis. We present a ligament reinforcement technique utilizing a flexible fixation device for the treatment of ligamentous Lisfranc injuries. Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Connor Delman
- Department of Orthopedics, University of California, Davis, Sacramento, CA, USA
| | - Midhat Patel
- Department of Orthopedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Mark Campbell
- The CORE Institute-Center for Orthopedic Research and Education, Phoenix, AZ, USA
| | - Christopher Kreulen
- Department of Orthopedics, University of California, Davis, Sacramento, CA, USA
| | - Eric Giza
- Department of Orthopedics, University of California, Davis, Sacramento, CA, USA
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Haraguchi N, Ota K, Ozeki T, Nishizaka S. Anatomical Pathology of Subtle Lisfranc Injury. Sci Rep 2019; 9:14831. [PMID: 31619712 PMCID: PMC6795995 DOI: 10.1038/s41598-019-51358-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/30/2019] [Indexed: 11/23/2022] Open
Abstract
The extent and patterns of Lisfranc joint complex disruption in subtle Lisfranc injuries have not been well clarified. We reviewed the direct intraoperative findings for 87 patients, examined computed tomography images that had been obtained preoperatively for 73 of the patients, and classified the injuries according to the Kaar et al. criteria as the transverse type (instability between the first cuneiform [C1] and the second metatarsal [M2] and between the second cuneiform [C2] and M2) or longitudinal type (instability between C1 and M2 and between C1 and C2). Our patients’ injuries were classified as follows: longitudinal type (38%), transverse type (30%), transverse type and first tarsometatarsal (TMT) joint injury (20%), longitudinal type plus transverse type (7%), longitudinal type and first TMT joint injury (3%), and longitudinal type, transverse type, and first TMT joint injury (2%). In 11 patients, the longitudinal injury extended into the naviculo-first cuneiform joint. In 41 (56%) of the 73 patients for whom CT images were obtained, 1 or more fractures (not counting small avulsion fragments between C1 and M2) were found. Orthopedic surgeons should be aware of the various injury patterns possible in cases of subtle Lisfranc injury.
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Affiliation(s)
- Naoki Haraguchi
- Department of Orthopaedic Surgery, St. Marianna University Yokohama Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan.
| | - Koki Ota
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital 4-22-1 Nakano, Nakanoku, Tokyo, 164-8541, Japan
| | - Takuma Ozeki
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital 4-22-1 Nakano, Nakanoku, Tokyo, 164-8541, Japan
| | - Shingo Nishizaka
- Department of Orthopaedic Surgery, Tokyo Metropolitan Police Hospital 4-22-1 Nakano, Nakanoku, Tokyo, 164-8541, Japan
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Raspovic KM, Anigian K, Kapilow J, Tisano B. Flexible Fixation in Foot and Ankle Surgery. Clin Podiatr Med Surg 2019; 36:553-562. [PMID: 31466567 DOI: 10.1016/j.cpm.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Flexible fixation has been described and utilized in various aspects of foot and ankle surgery over the past several decades. In regards to ankle surgery, flexible fixation devices have been used for stabilization of the ankle syndesmosis and augmentation of lateral collateral ankle ligament repair. In the foot, flexible fixation devices have been incorporated into hallux valgus or varus correction, Lisfranc injury repair, and more recently spring ligament repair augmentation. This article reviews the various applications for flexible fixation in foot and ankle surgery, as well as evidence-based literature on surgical applications and clinical outcomes.
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Affiliation(s)
- Katherine M Raspovic
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390, USA.
| | - Kendall Anigian
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390, USA
| | - Jaclyn Kapilow
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390, USA
| | - Breann Tisano
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390, USA
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Ligamentous Lisfranc Injury: A Biomechanical Comparison of Dorsal Plate Fixation and Transarticular Screws. J Orthop Trauma 2019; 33:e270-e275. [PMID: 31136372 DOI: 10.1097/bot.0000000000001466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Optimal fixation technique after purely ligamentous Lisfranc injury remains controversial. This biomechanical study compares dorsal plate versus transarticular screw fixation by measuring dorsal and plantar joint diastasis. A unique protocol was developed, using reflective triad markers and positional cameras. METHODS Eleven cadaveric matched pairs were assigned to either transarticular screw or dorsal plate fixation. Two reflective triad markers were placed into the medial cuneiform (C1) and second metatarsal base (MT2). Three cameras recorded the 3-dimensional location of triads to quantify C1-MT2 diastasis in the following states: intact Lisfranc ligament (INTACT), cut ligament (CUT), fixed (SCREW or PLATE) joint, and fixed joint after 10,000 loaded cycles. On completion, the plantar Lisfranc ligament insertions were identified, and plantar diastasis was determined using additional reflective triads. Statistical post hoc pairwise comparisons assessed differences in diastasis. RESULTS C1-MT2 diastasis in the CUT state increased relative to INTACT (P < 0.001). SCREW fixation reduced C1-MT2 diastasis relative to CUT at dorsal (P < 0.007) and plantar (P = 0.015) locations after cycling. PLATE fixation significantly reduced dorsal diastasis relative to CUT (P < 0.001) but not for plantar diastasis (P > 0.99). PLATE plantar diastasis was numerically higher than INTACT but not significantly (P > 0.39). PLATE plantar diastasis tended to be greater than SCREW before cycling (P = 0.068) and after cycling (P = 0.080). CONCLUSIONS Transection of the Lisfranc ligament complex yielded C1-MT2 diastasis. Both SCREW and PLATE fixation successfully reduced dorsal diastasis. However, upon load, the PLATE resulted in greater plantar diastasis, nearly statistically different relative to the SCREW. Cyclic loading at 343 N did not worsen diastasis.
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Lisfranc open reduction and internal fixation in an athletic population: screw versus suture button fixation. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hopkins J, Nguyen K, Heyrani N, Shelton T, Kreulen C, Garcia-Nolen T, Christiansen BA, Giza E. InternalBrace has biomechanical properties comparable to suture button but less rigid than screw in ligamentous lisfranc model. J Orthop 2019; 17:7-12. [PMID: 31879465 DOI: 10.1016/j.jor.2019.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/16/2019] [Indexed: 10/26/2022] Open
Abstract
Purpose The aim of this study was to investigate the biomechanical properties of the InternalBrace for lisfranc injuries. Methods A Sawbone model was developed comparing screw, suture button and InternalBrace. Results When loaded in axial tension at 0.5 mm/s, the screw was stiffest (2,240 N/mm), while the InternalBrace (200 N/mm) was stiffer than the suture button (133 N/mm). Cyclic loading with 10,000 cycles of 69 N, 138 N, and 207 N showed the InternalBrace maintained stiffness, but fatigued earlier than the suture button. Conclusion The mechanical properties of the InternalBrace support clinical use, but further studies are needed regarding early weight bearing.
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Affiliation(s)
- Justin Hopkins
- Department of Orthopaedic Surgery, University of California Davis, 48600 Y St, Suite 3800, CA, 95817, USA
| | - Kevin Nguyen
- School of Medicine, University of California Davis, 4610 X St, Sacramento, CA, 95817, USA
| | - Nasser Heyrani
- Department of Orthopaedic Surgery, University of California Davis, 48600 Y St, Suite 3800, CA, 95817, USA
| | - Trevor Shelton
- Department of Orthopaedic Surgery, University of California Davis, 48600 Y St, Suite 3800, CA, 95817, USA
| | - Christopher Kreulen
- Department of Orthopaedic Surgery, University of California Davis, 48600 Y St, Suite 3800, CA, 95817, USA
| | - Tanya Garcia-Nolen
- JD Wheat Veterinary Orthopedic Research Laboratory, University of California, Davis, CA, One Shields Avenue, Davis, CA, 95616, USA
| | - Blaine A Christiansen
- Department of Orthopaedic Surgery, University of California Davis, 48600 Y St, Suite 3800, CA, 95817, USA
| | - Eric Giza
- Department of Orthopaedic Surgery, University of California Davis, 48600 Y St, Suite 3800, CA, 95817, USA
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Jastifer JR, Christianson ER, VanZweden DJ, Gustafson PA. Feasibility of Transosseous Nonarticular Fixation of Lisfranc Injuries. Foot Ankle Int 2019; 40:672-678. [PMID: 30803261 DOI: 10.1177/1071100719830947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal techniques for Lisfranc open reduction and internal fixation techniques remain debated. The purpose of the current study was to describe the joints involved in Lisfranc fixation and to determine if nonarticular transosseous internal fixation would be possible. METHODS Twenty cadaver Lisfranc joints were dissected and the articular cartilage was quantified by calibrated digital imaging software. Utilizing CT data, a computational model of the foot was developed and the mean joint surface was mapped and nonarticular screw paths between bones was determined. RESULTS For the medial-middle cuneiform (C1-C2) connection, 27.3% of the lateral face of C1 and 43.7% of the medial face of C2 was articular cartilage. Three variations of articular morphology were observed on C1 and 2 on C2. From the 3D models, it was determined that a joint-sparing, transosseous screw trajectory was possible between C1 and the second metatarsal and between C1 and C2. These screw paths were large enough to accommodate clinically useful screw diameters (>5 mm). The screw trajectories were roughly perpendicular to the long axis of the foot and take a plantar-medial to dorsal-lateral orientation. CONCLUSION The articular surface of the Lisfranc joint was quantified for the first time and may be smaller than some surgeons realize. This study demonstrated the orientation required to minimize articular damage. CLINICAL RELEVANCE The clinical significance of the current study was that a nonarticular screw trajectory was possible, and this information may help guide the placement of these screws.
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Affiliation(s)
- James R Jastifer
- 1 Borgess Orthopedics, Kalamazoo, MI, USA.,2 WMU Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Tzatzairis T, Firth G, Parker L. Adolescent Lisfranc injury treated with TightRope TM: A case report and review of literature. World J Orthop 2019; 10:115-122. [PMID: 30788228 PMCID: PMC6379736 DOI: 10.5312/wjo.v10.i2.115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/14/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lisfranc injuries are rare and can be easily missed. This injury is extremely rare in children, with limited published data. Different treatment options have been described; one of the options in adults is the “mini” TightRope™ Syndesmosis Device that provides non-rigid fixation with impressive results. However, there is no reference regarding the use of this device in children.
CASE SUMMARY We describe the case of an 11-year-old girl who sustained a Lisfranc injury of her right foot that was initially missed in the Accident and Emergency department of her local hospital. This case was a ligamentous/periosteal sleeve avulsion type of Lisfranc injury and a percutaneous technique using the “mini” TightRope™ syndesmosis device was used. Clinical and radiological results were excellent at final follow up.
CONCLUSION The “mini” TightRope™ syndesmosis device is a promising method of fixation for children with certain Lisfranc injuries. This method has many advantages, including the non-rigid type of the fixation and no need for subsequent metalwork removal.
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Affiliation(s)
- Themistoklis Tzatzairis
- Royal London Hospital, Paediatric Orthopaedic Department, Barts NHS Trust, London E1 2AA, Whitechapel, United Kingdom
| | - Gregory Firth
- Royal London Hospital, Paediatric Orthopaedic Department, Barts NHS Trust, London E1 2AA, Whitechapel, United Kingdom
| | - Lee Parker
- Royal London Hospital, Foot and Ankle Orthopaedic department, Barts NHS Trust, London E13 8SL, United Kingdom
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Ho NC, Sangiorgio SN, Cassinelli S, Shymon S, Fleming J, Agrawal V, Ebramzadeh E, Harris TG. Biomechanical comparison of fixation stability using a Lisfranc plate versus transarticular screws. Foot Ankle Surg 2019; 25:71-78. [PMID: 29409256 DOI: 10.1016/j.fas.2017.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/28/2017] [Accepted: 08/08/2017] [Indexed: 02/04/2023]
Abstract
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. A novel dorsal plate is introduced, intended to provide transverse and longitudinal stability, without injury to the articular cartilage. METHODS A biomechanical cadaver model was developed to compare the fixation stability of a novel Lisfranc plate to that of traditional fixation, using transarticular screws. Thirteen pairs of cadaveric specimens were tested intact, after a simulated Lisfranc injury, and then following implant fixation, using one method of fixation randomly assigned, on either side of each pair. Optical motion tracking was used to measure the motion between each of the following four bones: 1st metatarsal, 2nd metatarsal, 1st cuneiform, and 2nd cuneiform. Testing included both cyclic abduction loading and cyclic axial loading. RESULTS Both the Lisfranc plate and screw fixation method provided stability such that the average 3D motions across the Lisfranc joint (between 2nd metatarsal and 1st cuneiform), were between 0.2 and 0.4mm under cyclic abduction loading, and between 0.4 and 0.5mm under cyclic axial loading. Comparing the stability of fixation between the Lisfranc plate and the screws, the differences in motion were all 0.3mm or lower, with no clinically significant differences (p>0.16). CONCLUSIONS Diastasis at the Lisfranc joint following fixation with a novel plate or transarticular screw fixation were comparable. Therefore, the Lisfranc plate may provide adequate support without risk of iatrogenic injury to the articular cartilage.
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Affiliation(s)
- Nathan C Ho
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children, in Alliance with UCLA, 403 W. Adams Blvd., Los Angeles, CA 90007, United States; University of Southern California Department of Biomedical Engineering, Los Angeles, CA, United States
| | - Sophia N Sangiorgio
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children, in Alliance with UCLA, 403 W. Adams Blvd., Los Angeles, CA 90007, United States; University of California, Los Angeles Department of Orthopaedic Surgery, Los Angeles, CA, United States.
| | - Spenser Cassinelli
- Los Angeles County Harbor-UCLA Medical Center, Los Angeles, CA, United States.
| | - Stephen Shymon
- Los Angeles County Harbor-UCLA Medical Center, Los Angeles, CA, United States.
| | - John Fleming
- Los Angeles County Harbor-UCLA Medical Center, Los Angeles, CA, United States.
| | - Virat Agrawal
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children, in Alliance with UCLA, 403 W. Adams Blvd., Los Angeles, CA 90007, United States; University of Southern California Department of Biomedical Engineering, Los Angeles, CA, United States.
| | - Edward Ebramzadeh
- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Orthopaedic Institute for Children, in Alliance with UCLA, 403 W. Adams Blvd., Los Angeles, CA 90007, United States; University of California, Los Angeles Department of Orthopaedic Surgery, Los Angeles, CA, United States.
| | - Thomas G Harris
- Los Angeles County Harbor-UCLA Medical Center, Los Angeles, CA, United States.
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Fernandez I, Weiss WM, Panchbhavi VK. Evaluation of the Area of the Lisfranc Ligament Damaged by Screw Fixation. Foot Ankle Spec 2019; 12:49-53. [PMID: 29575922 DOI: 10.1177/1938640018766605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A cannulated screw is currently the standard fixation method to reduce and stabilize diastasis at the lisfranc joint following injury. Currently, there is no literature examining the area of the lisfranc ligament damaged by screw placement. The objective of this investigation is to define the area of the ligament damaged by fixation with a 3.5-mm cannulated screw. MATERIALS AND METHODS Twelve cadaveric feet were dissected to identify the Lisfranc ligament metatarsal insertion site and origin on the medial cuneiform. A 3.5-mm cannulated screw was then passed over the course of the ligament and removed. The Lisfranc joint was then dissected to measure the dimensions of the ligament and damage from screw passage at the origin and insertion using imaging software. RESULTS Mean injury area on the metatarsal was 3.49 mm2 and the area of injury for the cuneiform was 3.33 mm2. The mean percent of the area damaged was calculated to be 1.75% and 2.43% at the cuneiform and metatarsal, respectively. CONCLUSION A proportionally small area of the Lisfranc ligament is disrupted following screw fixation, but the implications of this on ligament healing and outcomes remain to be elucidated. LEVELS OF EVIDENCE Level V: Cadaveric study.
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Affiliation(s)
- Isaac Fernandez
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech Health Sciences Center, El Paso, Texas (IF, WMW).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (VKP)
| | - William M Weiss
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech Health Sciences Center, El Paso, Texas (IF, WMW).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (VKP)
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech Health Sciences Center, El Paso, Texas (IF, WMW).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (VKP)
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Abstract
PURPOSE OF REVIEW To outline the classic and recent literature of midfoot fractures and dislocations. RECENT FINDINGS There has been an evolution of implant technology to include mini-fragment fixation, suture fixation, and staples. Their efficacy is still being elucidated in the literature. Also, there has been a recent push for primary fusion, which we will discuss. Open reduction internal fixation of the midfoot remains to be the gold standard treatment, to which all other treatments are compared. It remains to be seen if adjunct fixation techniques are efficacious enough to provide a good result. Further study is needed to determine which patients are likely to progress to debilitating arthrosis and require fusion.
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Affiliation(s)
- Atif Ahmed
- Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Edward Westrick
- Allegheny General Hospital, 1307 Federal Street, Pittsburgh, PA, 15212, USA
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