Aims. This systematic review and meta-analysis was conducted to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA) in the treatment of Lisfranc injuries, regarding patient-reported outcome measures (PROMs), and risk of secondary surgery. The aim was to conclusively determine the best available treatment based on the most complete and recent evidence available. Methods. A systematic search was conducted in PubMed, Cochrane Controlled Register of Trials (CENTRAL), EMBASE, CINAHL, PEDro, and SPORTDiscus. Additionally, ongoing trial registers and reference lists of included articles were screened. Risk of bias (RoB) and level of evidence were assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The random and fixed-effect models were used for the statistical analysis. Results. A total of 20 studies were selected for this review, of which 12 were comparative studies fit for meta-analysis, including three randomized controlled trials (RCTs). This resulted in a total analyzed population of 392 patients treated with ORIF and 249 patients treated with PA. The mean differences between the two groups in American Orthopedic Foot and Ankle Society (AOFAS), VAS, and SF-36 scores were -7.41 (95% confidence interval (CI) -13.31 to -1.51), 0.77 (95% CI -0.85 to 2.39), and -1.20 (95% CI -3.86 to 1.46), respectively. Conclusion. This is the first study to find a statistically significant difference in PROMs, as measured by the AOFAS score, in favour of PA for the treatment of Lisfranc injuries. However, this difference may not be clinically relevant, and therefore drawing a definitive conclusion requires confirmation by a large prospective high-quality RCT. Such a study should also assess cost-effectiveness, as cost considerations might be decisive in decision-making. Level of Evidence: I. Cite this article: Bone Jt Open 2021;2(10):842–849

The results of treatment of Lisfranc injuries are often unsatisfactory. This retrospective study investigated 46 patients with isolated Lisfranc injuries at a minimum of two years after surgery. Thirteen patients had a poor outcome and had to change employment, or were unable to find work as a result of this injury. The presence of a compensation claim (p = 0.02) and a delay in diagnosis of more than six months were associated with a poor outcome (p = 0.01). There was no association between poor functional outcome and age, gender, mechanism of injury or previous occupation. This study may have medico-legal implications on reporting the prognosis for such injuries, and highlights the importance of prompt diagnosis and treatment

Introduction. Lisfranc joint injuries are increasingly recognised in elite soccer and rugby players. Currently no evidence-based guidelines exist on timeframes for return to training and competition following surgical treatment. This study aimed to see whether return to full competition following surgery for Lisfranc injuries was possible in these groups and to assess times to training, playing and possible related factors. Material/Methods. Over 46-months, a consecutive series of fifteen professional soccer (6) and rugby(9) players in the English Premierships/Championship, was assessed using prospectively collected data. All were isolated injuries, sustained during competitive matches. Each had clinical and radiological evidence of injury and was treated surgically within thirty-one days. A standardised postoperative regime was used. Results. Follow-up was obtained in all fifteen cases. Eight cases were ligamentous injuries and seven were bony. Time from injury to fixation ranged from 10–31 days. One athlete retired following a ligamentous injury. All remaining fourteen returned to training and full competition. Excluding the retired case, mean return to training time was 20.2 weeks and to full competition was 25.6 weeks. No significant difference existed between the mean return to competition time for rugby (27.8 weeks) and soccer(24.7 weeks). A significant difference existed between the mean return to competition time for ligamentous (23.7 weeks) compared to bony(27.6 weeks) injuries(p = 0.012). Three patients suffered deep peroneal nerve sensation loss, two of which fully recovered. Discussion/Conclusion. Return to competitive elite-level soccer and rugby is possible following surgically treated Lisfranc injuries. Return to training can take up to 24 weeks and playing up to 31 weeks, with bony injuries taking longer. To our knowledge this is the largest series of its kind and whilst we recognise it contains small numbers, we feel it provides some guidance on rehabilitative timeframes for those who treat and those who sustain these injuries. Evidence Level: 4

Background. Anatomical reduction and stable internal fixation has been recommended as the standard treatment for fracture dislocations of the tarsometatarsal (Lisfranc) joint. Many methods of fixation have been utilised including K-wires and screw fixation, the latter being the preferred method as it provides a stronger more stable construct. However, the screws require removal after the injury has healed. We present a different method and technique of stabilisation utilising memory staples. The technique is extra-articular and avoids breaching the TMTJ joint surface, is simple and avoids the necessity of removal of hardware. Methods. 11 patients with isolated ligamentous Lisfranc injuries were treated with memory staple fixation over the past 4 years at our centre. Patients' outcome was assessed with use of the Foot & Ankle Disability Index (FADI) Score, the American Foot & Ankle Score, radiographic and clinical follow-up at an average time of 2 years post surgery. Results. The average FADI score was 86.4 (on a scale of 100 points, with 100 points indicating an excellent outcome). The average American Foot & Ankle score was 90 out of a 100. All patients demonstrated stable long term reduction of the TMT joints and none have required subsequent fusion. In all but 1 patient, there had been fatigue failure of the memory staples making hardware removal unnecessary. Conclusion. Internal fixation of Lisfranc joint fracture-dislocation with memory staples is an effective fixation method with results comparable to conventional screw fixation with the added benefit of alleviating the need for further surgery to remove the metal work

Introduction

In this study we decided to observe the incidence of osteoarthritis following ORIF of Lisfranc joint injury. We also intended to point out the influence of different factors such as late diagnosis of the fracture, co-fractures, and open or close fractures on the incidence of osteoarthritis.

Introduction. Lisfranc joint injuries account for only 0.2% of all fractures but early diagnosis improves the chances of a better outcom]. Radiographic signs, such as diastasis (>2mm) of the 1–2 interspace, are subtle and. often missed, leading to a poorer outcome. We present a new radiographic sign, less likely to result in missed diagnoses. Null nypothesis: The intermetarsal angle remains unchanged in Lisfranc injuries. Method. A series of radiographs demonstrating Lisfranc injury were interspersed with normal and postoperative cases. Evidence of fixation was obscured. A selection of Foundation and Core Trainee medical staff measured the intermetatarsal angle (IMA) on two separate occasions. The measuring technique was demonstrated with no explanation for the reason behind the measurement. Results. The intra-class correlation (ICC) between observers was 0.96 and a mean 0.86 (range 0.69–0.96) for individual observers. IMA on comparative weight bearing AP views of injured and normal side, using Wilcoxon-signed rank test demonstrated a P< 0.0001 with mean values of 6.6 degrees (normal) versus 4.85 degrees (injured) and standard deviation of 1.97 & 1.91 degrees respectively. Conclusion. The high ICC value suggests that this radiographic sign is easily taught, reliable and reproducible. Analysis of individual angles suggests that there is a significant difference between the normal and pathological IMA. We therefore reject our null hypothesis. The data supports our proposition that that the IMA becomes more parallel in Lisfranc injuries and that this is an easily recognised sign, which could help reduce the incidence of missed injuries. Elucidation of the exact anatomical pathology responsible is the basis for further, anatomical, studies

There is debate whether a home run screw (medial cuneiform to 2nd metatarsal base) combined with k-wire fixation of 4th & 5th rays is sufficient to stabilise Lisfrance injuries or if fixation of the 3rd ray is also required. Unlike the 2nd, 4th and 5th TMTJ, stabilisation of the 3rd requires either intra-articular screw or a cross joint plate which both risk causing chondrolysis and/or OA.

Using 8 Theil embalmed specimens, measurements of TMTJ dorsal displacement at each ray (1st to 5th) and 1st – 2nd metatarsal gaping were made during simulated weight bearing with sequential ligamentous injury and stabilisation to determine the contribution of anatomical structures and fixation to stability.

At baseline mean dorsal TMTJ displacement of the intact specimens during simulated weight bearing (mm) was: 1st: 0.14, 2nd: 0.1, 3rd:0, 4th: 0, 5th: 0.14. The 1st-2nd IM Gap was 0mm. After transection of the Lisfranc ligament only, there was 1st-2nd intermetatarsal gaping (mean 4.5mm), but no increased dorsal displacement. After additional transection of all the TMTJ ligaments dorsal displacement increased at all joints (1st: 4.5, 2nd: 5.1, 3rd: 3.6, 4th: 2, 5th: 1.3). Stabilisation with the home run screw and 4th and 5th ray k-wires virtually eliminated all displacement. Further transection of the 3rd/4th inter-metatarsal ligaments increased mean dorsal displacement of the 3rd ray to 2.5mm. K-wire fixation of the 3rd ray completely eliminated dorsal displacement.

The results suggest that stabilising the 2nd and 4/5th TMTJs will stabilise the 3rd if the inter-metatarsal ligaments are intact. Thus 3rd TMTJ stability should be checked after stabilising the 2nd and 4/5th. Provided the intermetatarsal ligaments (3rd-4th) are intact the 3rd ray does not need to be stabilised routinely.

Lisfranc injuries account for 0.2% of all fractures and have been linked to poorer functional outcomes, in particular resulting in post-traumatic arthritis, midfoot collapse and chronic pain. This study assesses the longitudinal functional outcomes in patients with low and high energy Lisfranc injuries treated both operatively and non-operatively. Patients above 16 years with Lisfranc injuries from January 2008 and December 2017 were identified through the Victorian Orthopaedic Trauma Outcomes (VOTOR) registry. Follow-up performed at 6, 12 and 24 months through telephone interviews with response rate of 86.1%, 84.2% and 76.2% respectively. Longitudinal functional outcome data using Global Outcome Assessment, EQ-5D-5L, numerical pain scale, Short-Form 12, the WHO Disability Assessment Schedule and return to work status were collected. Univariate analysis was performed and variables showing a significant difference between groups (p < 0.25) were analysed with multivariable mixed effects regression model. 745 patients included in this retrospective cohort study. At 24 months, both the operative and non-operative groups demonstrated similar functional outcomes trending towards an improvement. Mixed effect regression models for the EQ items for mobility (OR 1.80, CI 0.91 – 3.57), self-care (OR 1.95, 95% CI 1.09-3.49), usual activities (OR 1.10, 95% CI 0.99-1.03), pain (OR 1.07, 95% CI 0.61-1.89), anxiety (OR 1.29, 95% CI 0.72-2.34) and pain scale (OR 1.07, 95% CI 0.51 – 2.22) and return to work (OR 1.28, 95% CI 0.56-2.91) between groups were very similar and not statistically significantly different. We concluded that there was no statistically significant difference between operative and non-operative patients with low and high energy Lisfranc injuries. Current clinical practices in Lisfranc injury management are appropriate and not inadvertently causing any further harm to patients. Future research comparing fracture patterns, fixation types and corresponding functional outcomes can help determine gold standard Lisfranc injury management

Background. Undisplaced Lisfranc-type injuries are subtle but potentially unstable fracture-dislocations with little known about the natural history. These injuries are often initially managed conservatively due to lack of initial displacement and uncertainty regarding subsequent instability at the tarsometatarsal joints (TMTJ). The aim of this study was to determine the secondary displacement rate and the need for delayed operative intervention in undisplaced Lisfranc injuries that were managed conservatively at initial presentation. Methods. Over a 6-year period (2011 to 2017), we identified 24 consecutive patients presenting to a university teaching hospital with a diagnosis of an undisplaced Lisfranc-type injury that was initially managed conservatively. Pre-operative radiographs were reviewed to confirm the undisplaced nature of the injury (defined as a diastasis< 2mm at the second TMTJ). The presence of a ‘fleck’ sign (small bony avulsion of the second metatarsal) was also noted. Electronic patient records and sequential imaging (plain radiographs/CT/MRI) were scrutinized for demographics, mechanism of injury and eventual outcome. Results. The mean age of the patients at the time of injury was 42 years (19 Female). 96% (23/24) were low energy injuries and 88% (21/24) had a positive ‘fleck sign’. The secondary displacement rate in this group of patients was 62.5% (15/24) over a median interval of 14 days (range 0 to 482 days). 12 patients underwent open reduction internal fixation after a median interval of 29 days (range 1 to 294 days) from their initial injury. One patient required TMTJ fusion at 19 months and two patients were managed non-operatively. The injury remained undisplaced in 37.5% patients (9/24) with only one patient requiring subsequent TMTJ fusion at 5 months. Conclusion. Undisplaced Lisfranc injuries have a high rate of secondary displacement and warrant close follow-up. Early primary stabilisation of undisplaced Lisfranc injuries should be considered to prevent unnecessary delays in surgical treatment

Background. Anatomical reduction of unstable Lisfranc injuries is crucial. Evidence as to the best methods of surgical stabilization remains sparse, with small patient numbers a particular issue. Dorsal bridge plating offers rigid stability and joint preservation. The primary aim of this study was to assess the medium-term functional outcomes for patients treated with this technique at our centre. Additionally, we review for risk factors that influence outcomes. Methods. 85 patients who underwent open reduction and dorsal bridge plate fixation of unstable Lisfranc injuries between January 2014 and January 2019 were identified. Metalwork was not routinely removed. A retrospective review of case notes was conducted. The Manchester-Oxford Foot Questionnaire summary index (MOXFQ-Index) was the primary outcome measure, collected at final follow-up, with a minimum follow-up of 24 months. The American Orthopedic Foot and Ankle Society (AOFAS) midfoot scale, complications, and all-cause re-operation rates were secondary outcome measures. Univariate and multivariate analyses were used to identify risk factors associated with poorer outcomes. Results. Mean follow-up 40.8 months (24–72). Mean MOXFQ-Index 27.0 (SD 7.1). Mean AOFAS score 72.6 (SD 11.6). 48/85 patients had injury patterns that included an intra-articular fracture and this was associated with poorer outcomes, with worse MOXFQ and AOFAS scores (both p < 0.001). 18 patients (21%) required the removal of metalwork for either prominence or stiffness. Female patients were more likely to require metalwork removal (OR 3.89, 95% CI 1.27 to 12.0, p = 0.02). Eight patients (9%) required secondary arthrodesis. Conclusions. This is the largest series of Lisfranc injuries treated with dorsal bridge plate fixation reported to date and the only to routinely retain metalwork. The technique is safe and effective. The presence of an intraarticular fracture is a poor prognostic indicator. Metalwork removal is more likely to be needed in female patients but routine removal may not be essential

Background. Lisfranc fracture dislocations are uncommon injuries, which frequently require surgical intervention. Currently, there is varying evidence on the diagnostic utility of plain radiographs (XR) and CT in identifying Lisfranc injuries and concomitant fractures. Our aim was to identify the utility of XR as compared to CT, with the nul hypothesis that there was no difference in fracture identification. Methods. A retrospective assessment of patients who had sustained a Lisfranc injury between 2013 and 2022 across two trauma centres within the United Kingdom who underwent surgery. Pre-operative XR and CT images were reviewed independently by 2 reviewers to identify the presence of associated fractures. Results. A total of 175 patients were included. Our assessment identified that XR images significantly under-diagnosed all metatarsal and midfoot fractures. The largest discrepancies between XR and CT in their rates of detection were in fractures of the cuboid (5.7% vs 28%, p<0.001), medial cuneiform (20% vs 51%, p=0.008), lateral cuneiform (4% vs 36%, p=0.113), second metatarsal (57% vs 82%, p<0.001), third metatarsal (37% vs 61%, p<0.001) and fourth metatarsal (26% vs 43%, p<0.001). As compared to CT, the sensitivity of XR was low. The lowest sensitivity for identification however was lateral foot injuries, specifically fractures of the lateral cuneiform (sensitivity 7.94%, specificity 97.3%), cuboid (sensitivity 18.37%, specificity 99.21%), fourth (sensitivity 46.7%, specificity 89.80%) and fifth metatarsal (sensitivity 45.00%, specificity 96.10%). Conclusion. From our analysis, we can determine that XR significantly under-diagnoses associated injuries in patient sustaining an unstable Lisfranc injury, with lateral foot injuries being the worst identified. We advised the use of CT imaging in all cases for appropriate surgical planning

The April 2023 Foot & Ankle Roundup. 360. looks at: Outcomes following a two-stage revision total ankle arthroplasty for periprosthetic joint infection; Temporary bridge plate fixation and joint motion after an unstable Lisfranc injury; Outcomes of fusion in type II os naviculare; Total ankle arthroplasty versus arthrodesis for end-stage ankle osteoarthritis; Normal saline for plantar fasciitis: placebo or therapeutic?; Distraction arthroplasty for ankle osteoarthritis: does it work?; Let there be movement: ankle arthroplasty after previous fusion; Morbidity and mortality after diabetic Charcot foot arthropathy

Being commonly missed in the clinical practice, Lisfranc injuries can lead to arthritis and long-term complications. There are controversial opinions about the contribution of the main stabilizers of the joint. Moreover, the role of the ligament that connects the medial cuneiform (MC) and the third metatarsal (MT3) is not well investigated. The aim of this study was to investigate the influence of different Lisfranc ligament injuries on CT findings under two specified loads. Sixteen fresh-frozen human cadaveric lower limbs were embedded in PMMA at mid-shaft of the tibia and placed in a weight-bearing radiolucent frame for CT scanning. All intact specimens were initially scanned under 7.5 kg and 70 kg loads in neutral foot position. A dorsal approach was then used for sequential ligaments cutting: first – the dorsal and the (Lisfranc) interosseous ligaments; second – the plantar ligament between the MC and MT3; third – the plantar Lisfranc ligament between the MC and the MT2. All feet were rescanned after each cutting step under the two loads. The average distances between MT1 and MT2 in the intact feet under 7.5 kg and 70 kg loads were 0.77 mm and 0.82 mm, whereas between MC and MT2 they were 0.61 mm and 0.80 mm, without any signs of misalignment or dorsal displacement of MT2. A slight increase in the distances MT1-MT2 (0.89 mm; 0.97 mm) and MC-MT2 (0.97 mm; 1.13 mm) was observed after the first disruption of the dorsal and the interosseous ligaments under 7.5 kg and 70 kg loads. A further increase in MT1-MT2 and MC-MT2 distances was registered after the second disruption of the ligament between MC and MT3. The largest distances MT1-MT2 (1.5 mm; 1.95 mm) and MC-MT2 (1.74 mm; 2.35 mm) were measured after the final plantar Lisfranc ligament cut under the two loads. In contrast to the previous two the previous two cuts, misalignment and dorsal displacement of 1.25 mm were seen at this final disrupted stage. The minimal pathological increase in the distances MT1-MT2 and MC-MT2 is an important indicator for ligamentous Lisfranc injury. Dorsal displacement and misalignment of the second metatarsal in the CT scans identify severe ligamentous Lisfranc injury. The plantar Lisfranc ligament between the medial cuneiform and the second metatarsal seems to be the strongest stabilizer of the Lisfranc joint. Partial lesion of the Lisfranc ligaments requires high clinical suspicion as it can be easily missed

Open reduction and internal fixation (ORIF) with trans-articular screws or dorsal plating is the standard surgical technique for displaced Lisfranc injuries. This aim of this study is to compare the clinical outcomes of percutaneous reduction and internal fixation (PRIF) of low energy Lisfranc injuries with a matched, control group of patients treated with ORIF. Over a seven-year period (2012–2019), 16 consecutive patients with a low energy Myerson B2-type injury were treated with PRIF. Patient demographics were recorded within a prospectively maintained database at the institution. This study sample was matched for age, sex and mechanism of injury to a control group of 16 patients with similar Myerson B2-type injuries treated with ORIF. Clinical outcome was compared using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and Manchester Oxford Foot Questionnaire (MOXFQ). At a mean follow up of 43.0 months (95% CI 35.6 – 50.4), both the AOFAS and MOXFQ scores were significantly higher in the PRIF group compared to the control ORIF group (AOFAS 89.1vs 76.4, p=0.03; MOXFQ 10.0 vs 27.6, p=0.03). There were no immediate postoperative complications in either group. At final follow up, there was no radiological evidence of midfoot osteoarthritis in any patient in the PRIF group. Three patients in the ORIF group developed midfoot osteoarthritis, one of whom required midfoot fusion. PRIF is a technically simple, less invasive method of operative stabilisation of low energy Lisfranc injures which also appears to be associated with better mid-term clinical outcomes compared to ORIF

Lisfranc injuries are uncommon and can be challenging to manage. There is considerable variation in opinion regarding the mode of operative treatment of these injuries, with some studies preferring primary arthrodesis over traditional open reduction and internal fixation (ORIF). We aim to assess the clinical and radiological outcomes of the patients treated with ORIF in our unit. This is a retrospective study, in which all 27 consecutive patients treated with ORIF between June 2013 and October 2018 by one surgeon were included with an average follow-up of 2.4 years. All patients underwent ORIF with joint-sparing surgery by a dorsal bridging plate (DBP) for the second and third tarsometatarsal (TMT) joint, and the first TMT joint was fixed with trans-articular screws. Patients had clinical examination and radiological assessment, and completed American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and Foot Function Index (FFI) questionnaires. Our early results of 22 patients (5 lost to follow-up) showed that 16 (72%) patients were pain free, walking normally without aids, and wearing normal shoes and 68% were able to run or play sports. The mean AOFAS midfoot score was 78.1 (63–100) and the average FFI was 19.5 (0.6–34). Radiological assessment confirmed that only three patients had progression to posttraumatic arthritis at the TMT joints though only one of these was clinically symptomatic. Good clinical and radiological outcomes can be achieved by ORIF in Lisfranc injuries with joint-sparing surgery using DBP

Introduction: Lisfranc injuries account for 0.2% of all fractures. Around 20% of these injuries are missed or misdiagnosed leading to long term problems with the foot. Early recognition and treatment of these injuries are crucial in restoring the function of the foot. Aim: To review the functional outcome of patients following surgery for lisfranc injuries. Methodology: This is a retrospective review of patients treated surgically for lisfranc injury in our hospital between January 2000 and January 2007. There were 13 patients whose records were reviewed and data including age, mechanism of injury, associated injuries, surgery performed, and peri-operative complications were collected. A telephonic survey was conducted to find out the current functional and employment status. AOFAS mid-foot score was used to evaluate the outcome. Results: 13 patients were included in the study. Mean age was 31 years at the time of injury. 5 patients were female and 8 male. 10 had injury on the left foot while 3 had on the right. 11 were closed lisfranc injury. 10 patients had isolated lisfranc injury. Seven patients had sustained lisfranc injury following a fall, while three had a road traffic accident. Six patients had a homo-lateral, four had isolated and two had divergent type. Nine patients had trans-articular fixation, seven of whom had open reduction and internal fixation while two had K-wire fixation. Extra-articular fixation was done in four patients. Average AOFAS mid foot scoring was 80 ranging from 47 to 100. Lower scores were related to pain. Nine patients were pain free at follow up and returned to work. Average follow-up period was 32.6 months (range5–77 months). Conclusion: Two thirds of patients with a Lisfranc fracture dislocation return to work and extra-articular fixation may result in superior outcomes compared with the traditional methods

Introduction: The unique architecture of the tarsometa-tarsal joints gives rise to a complex articulation between the midfoot and forefoot. The Lisfranc injury has a classic pattern leaving its telltale signs in an arch pattern starting at the medial cuneiform, continuing through the second, third and fourth tarsometatarsal regions and finally may end as a fracture of the cuboid. However, various other patterns and classifications of Lisfranc fracture dislocation have been recorded in medical literature. Aim: To highlight the hitherto undescribed arch patterns of Lisfranc injuries. Methodology: 8 patients with atypical Lisfranc injuries were studied prospectively. Arch patterns: In 2 patients the arch started at the medial aspect of the ankle with injury to the medial malleolus or the deltoid ligament, passed through the tarsometatarsal region and ended at the cuboid. In one patient the arch started at the tarsometatarsal joints and ended at the lateral malleolus and in another patient the lateral end point resulted in tear of the calcaneofibular ligament. One patient had the medial starting point at the Lisfranc ligament but the arch of injuries went through the forefoot fracturing the midshaft of the 2nd, 3rd and 4th metatarsal shafts without injuring the tarsometatarsal region, thus forming an arch pattern much more distal than usual. Six of the 8 patients had operative management. On follow up, in terms of activities of daily living, 75% had excellent function of the foot. It is not the aim of this paper to highlight the management of these injuries. Conclusion: In the process of listing the telltale signs of a Lisfranc injury it is mandatory to bear in mind that the arch of injuries may extend to as proximal as the ankle joint or as distal as the forefoot and this will enable us to define the entire spectrum of the Lisfranc injury, however atypical it may be

Anatomical variation of Lisfranc mortise has been implicated in the susceptibility of Lisfranc fracture-dislocation. We investigated whether the variations in the dimensions of second metatarsal base makes the joint vulnerable to fracture dislocation. Patients and Methods: 31 normal (group A) and 23 injured (group B) foot x-rays were compared. The average age of patients was 33(range 16–64) years. Routine AP and 45 degree oblique foot x-rays were used to measure second metatarsal parameters such as L (length of second metatarsal) were measured on x-rays in both groups. Additionally D (height of base of second metatarsal in sagittal plane of foot) was measured in CT scans. Statistical analysis was performed to test the viability of the null hypothesis that states that the relationship of second metatarsal length and height at the base does not correlate with increased susceptibility of Lisfranc injury. Similar analyses of the relevant parameters at the second metatarsal mortice were also calculated. Results: Mean values of D, L and D/L were obtained in both groups. Statistically the value of D/L was found to be significantly different between injured group and normal group, with a P value of 0.03, while the values of length of second metatarsal itself was not significantly different between two groups (P=0.15). However, no significant correlation was noticed using other parameters of the second metatarsal mortice. Conclusion: Previously shallowness of the second metatarsal mortice was shown to be significantly correlated with increased risk of Lisfranc injury. However, this study suggests that dimensions of second metatarsal such as, depth/length of the second metatarsal significantly increase the risk of Lisfranc injury. In other words more slender metatarsal dimensions at its base carry increased risk to Lisfranc injury. Thus, anatomical variation at the base of the second metatarsal makes the Lisfranc joint susceptible to injury

The December 2015 Foot & Ankle Roundup. 360 . looks at: The midfoot fusion bolt: has it had its day?; Ankle arthroplasty: only for the old?; A return to the Keller’s osteotomy for diabetic feet?; Joint sparing surgery for ankle arthritis in the context of deformity?; Beware the subtalar fusion in the ankle arthrodesis patient?; Nonunion in the foot and ankle a predictive score; Cast versus early weight bearing following Achilles tendon repair; Should we plate Lisfranc injuries?

Lisfranc injuries are not the common injuries of foot and ankle but there has been an increase in the incidence of these injuries due to road traffic accidents and fall from heights. We wish to present our retrospective case series of the operative management of the Lisfranc injuries by our senior author. We retrospectively reviewed 68 patients with Lisfranc injuries who were managed operatively by the senior author over the last six years. The case note and the radiographs including the CT scans were reviewed. All of them were treated with open reduction and internal fixation within three weeks of injury. The male: female ratio was 43:25. 37 right: 31 left sided injuries. The average age was 40.6 years (range 16 – 81 years). The most common mechanism of injury was fall from steps at home followed by motor bike accident. They average follow-up was 19.5 months and they were assessed both clinically and radiographically at each follow-up. The k wires were removed at an average of six weeks. 96% were pain free and fully weight bearing after six months. Two patients had lateral scar tenderness. Majority of them returned to normal activities at an average of 12 months. Two patients had initial wound complications which were treated successfully with oral antibiotics. None of them had degenerative changes. Our results of early open reduction and internal fixation were comparable to the published literature