Aims

The aim of this retrospective study was to compare the functional and radiological outcomes of bridge plating, screw fixation, and a combination of both methods for the treatment of Lisfranc fracture dislocations.

Aim

Anatomical reduction and Stable fixation of Lisfranc injuries is considered the gold standard. There is controversy about how it is best achieved. Some surgeons would advocate routine open anatomical reduction, which as a concept was popular in 1980s but the same anatomical reduction and fixation can be achieved percutaneously. We describe our method of close reduction and percutaneous fixation and present our results.

The April 2023 Trauma Roundup. 360. looks at: Displaced femoral neck fractures in patients aged 55 to 70 years: internal fixation or total hip arthroplasty?; Tibial plateau fractures: continuous passive motion approves range of motion; Lisfranc fractures: to fuse or not to fuse, that is the question; Is hardware removal after clavicle fracture plate fixation beneficial?; Fixation to coverage in Grade IIIB open fractures – what’s the time window?; Nonoperative versus locking plate fixation in the proximal humerus; Retrograde knee nailing or lateral plate for distal femur fractures?

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 Lisfranc fracture dislocation of the tarsometatarsal joint (TMTJ) is a complex injury with a reported incidence of 9.2 to 14/100,000 person-years. Lisfranc fixation involves dorsal bridge plating, transarticular screws, combination or primary arthrodesis. We aimed to identify predictors of poor patient reported outcome measures at long term follow up after operative intervention. 127 patients underwent Lisfranc fixation at our Level One Trauma Centre between November 2007 and July 2013. At mean follow-up of 10.7 years (8.0-13.9), 85 patients (66.92%) were successfully contacted. Epidemiological data including age, gender and mechanism of injury and fracture characteristics such as number of columns injured, direction of subluxation/dislocation and classification based on those proposed by Hardcastle and Lau were recorded. Descriptive analysis was performed to compare our primary outcomes (AOFAS and FFI scores). Univariate analysis and multivariate regression analysis was done adjusted for age and sex to compare the entirety of our data set. P<0.05 was considered significant. The primary outcomes were the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score and the Foot Function Index (FFI). The number of columns involved in the injury best predicts functional outcomes (FFI, P <0.05, AOFAS, P<0.05) with more columns involved resulting in poorer outcomes. Functional outcomes were not significantly associated with any of the fixation groups (FFI, P = 0.21, AOFAS, P = 0.14). Injury type by Myerson classification systems (FFI, P = 0.17, AOFAS, P = 0.58) or open versus closed status (FFI, P = 0.29, AOFAS, P = 0.20) was also not significantly associated with any fixation group. We concluded that 10 years post-surgery, patients generally had a good functional outcome with minimal complications. Prognosis of functional outcomes is based on number of columns involved and injured. Sagittal plane disruption, mechanism and fracture type does not seem to make a difference in outcomes

Lisfranc fracture dislocations of the midfoot are uncommon but serious injuries, associated with posttraumatic arthrosis, progressive deformity, and persistent pain. Management of the acute injury aims to restore anatomic tarsometatarsal alignment in order to minimise these complications. Reduction and stabilisation can be performed using image-guided percutaneous reduction and screw stabilisation (aiming to minimise the risk of wound infection) or through open plating techniques (in order to visualise anatomic reduction, and to avoid chondral damage from transarticular screws). This retrospective study compares percutaneous and open treatment in terms of radiographic reduction and incidence of early complications. Case records and postoperative radiographs of all patients undergoing reduction and stabilisation of unstable tarsometatarsal joint injuries between 2011 and 2014 in our institution were reviewed. Dorsoplantar, oblique and lateral radiographs were assessed for accuracy of reduction, with malreduction being defined as greater than 2mm tarsometatarsal malalignment in any view. The primary outcome measure was postoperative radiographic alignment. Secondary outcome measures included the incidence of infection and other intra- or early postoperative complications. During the study period, 32 unstable midfoot injuries were treated, of which 19 underwent percutaneous reduction and screw stabilisation and 13 underwent open reduction and internal fixation. Of the percutaneous group, no wound infections were reported, and there were four (21.1%) malreduced injuries. Of the open group, two infections (15.4%) were observed, and no cases of malreduction. In conclusion, our study shows a strong trend towards increased risk of malreduction when percutaneous techniques are used to treat midfoot injuries, and an increased risk of infection when open surgery is used. Whilst conclusions are limited by the retrospective data collection, this study demonstrates the relative risks to consider when selecting a surgical approach

Injuries to the tarsometatarsal joint complex are uncommonly recognised. Many treatment modalities have been advocated. In recent years anatomic reduction and temporary rigid fixation with trans -articular screws has become popular. This is a study conducted over a period of at least two years. It reviews the management and subsequent outcome of a series of consecutive patients with an average age of 40.1 who suffered tarsometatarsal injury, or Lisfranc fracture. Anatomic or near anatomic reduction was achieved using temporary bridging plate fixation of the TMT joints and occasionally also with second metatarsal base medial cuneiform screw fixation. Two years post surgery a good or excellent functional result was generally achieved; however midfoot stiffness was a common problem

Diagnosis. a. History and exam. i. True Lisfranc fracture dislocations are NOT difficult to diagnose. b. Midfoot sprains or subtle injuries. i. These are DIFFICULT to diagnose. - subtle x-ray findings with minimal displacement. i) Exam: - be “suspicious” of midfoot sprains. - TMT tenderness, swelling. - inability to WB. ii) Mechanism of injury:. - indirect twisting injury (athletic). - crush injury of the foot (trauma). - axial forefoot loading (dancers, jumpers). iii) Investigations:. - X-rays usually normal or subtle widening. need to assess all 3 views in detail. standing AP compare to the other side. -Stress x-rays: - if clinical symptoms indicate - severe injury + pain but x-ray looks normal. - MRI useful for anatomic/instability correlation. - CT scan good for subtle injuries/fractures and displacement. - Bone scan positive in subacute/chronic pain situation. Treatment. a) Surgical Indications. i) Any displacement/positive stress xrays/test. ii) Surgical technique. - open reduction or closed and percutaneus fixation. - anatomic reduction essential. - NWB period up to 6 weeks. - WB with protection for another 4-6 weeks. iii. Screw vs tightrope fixation. iv. Hardware removal. b) Non-operative. i) Stable non-displaced sprain (need to make sure this is stable, ie stress views). - 6 to 8 weeks NWB. - expect prolonged recovery up to 6 months with. proper treatment. Controversial Issues:. a. Do all injuries with mild displacement have to be fixed operatively?. b. Arthrodesis vs fixation for soft tissue lisfranc with mild displacement?. c. Arthrodesis vs fixation subacute or chronic presentation?. d. Hardware removal?

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

Aims

The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates.

Lisfranc injury is named after Jacques Lisfranc, a field surgeon in Napoleon’s army. Based on Columnar classification of Lisfranc fracture dislocation, study of injury to medial column was carried out as they have the potential to be a severe cause of residual disability in the foot if not properly treated at the initial stage. Importance of Medial column is that it forms the highest point of longitudinal arch and may be injured in isolation or in association with lateral and middle column. Complex deforming forces may cause unusual pattern of medial column injuries at more than one level. There is renewed interest in this injury over past decade as modalities of treatment have changed over a period of time from conservative to fixation with K-wires to rigid fixation with screws to fixation with absorbable screws or combination of above. We present 21 cases of medial column injuries in Lis-franc fracture-dislocation. Age ranged from 18 to 65 yrs. All were male. Four fixed with compression screws,12 fixed with K-wires, 2 managed conservatively, 3 were neglected cases. Post-operatively POP back splint was given, K-wire removal at 8 weeks, screw removal after 12 weeks and partial weight bearing started at 8-12 weeks. Follow-up ranged from 3 months to 3 years. They were graded on basis of residual pain, foot shape, and movements. Best results were seen in cases where rigid intertarsal / intercolumnar stability was achieved by screw fixation. There was residual inter-cuneiform subluxation in 4 cases, which were fixed with K-wires, and this led to residual pain. Conservative/neglected cases had poor results. Intercolumnar / intertarsal instabilities should be primarily recognized and stabilized under compression. Stabilization should not only be within the 3 columns but also intercolumnar, thus maintaining the relative length of 3 columns and hence reconstitution of medial longitudinal arch

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

Purpose: Severe trauma in the mid-foot induces various foot deformities, causing pain. The mechanism and treatment of foot deformities following mid-foot trauma were evaluated. Materials: We evaluated feet showing dislocation and/or fracture of 2 or more joints or 2 or more tarsal bones encountered at our department between 1983 and 1996. The subjects were 24 males (26 feet) and 8 females (8 feet) aged 21–58 years (mean, 37 years). The injury that caused foot deformities was navicular bone fracture in 1 case, Chopart dislocation in 3, Lisfranc dislocation in 23, and fracture dislocation of the cuneiform in 5, The follow-up period was 2 years and 4 months _ 8 years (mean, 4 years and 9 months). Deformities occurred in these cases and associated factors were evaluated. Results: Flat foot deformity occurred in the 1 case of navicular bone dislocation and 2 of fracture dislocation of the cuneiform. Cavovarus deformity occurred in the 6 cases of Lisfranc fracture dislocation. Other deformities were observed in 3 feet. All patients complained of pain and fatigability during walking and were treated by corrective osteotomy and arthrodesis. Though the pain reduced, discomfort in the foot persisted, making heavy labor impossible in 3 cases. Discussion: In the mid-foot, there are many small tarsal bones, to which many tendons and ligaments are attached, forming the foot arch. Even though injury of one joint or one ligament (tendon), foot deformity can be induced. It is also possible that intraarticular injury was already severe at the time of injury, inducing secondary deformity. In trauma of the mid-foot involving multiple joints, the injured area should be adequately evaluated by preoperative stress X-P or MRI

Aims

It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was to assess differences in the outcome of patients treated between sites treating COVID-19 and a separate surgical site.

Aims

The aim of this study was to evaluate the functional outcome in patients undergoing implant removal (IR) after fracture fixation below the level of the knee.

The October 2014 Trauma Roundup³⁶⁰ looks at: proximal humeral fractures in children; quadrilateral surface plates in transverse acetabular fractures; sleep deprivation and poor outcomes in trauma; bipolar hemiarthroplasty; skeletal traction; forefoot fractures; telemedicine in trauma; ketamine infusion for orthopaedic injuries; and improved functional outcomes seen with trauma networks.

Injuries to the foot in athletes are often subtle and can lead to a substantial loss of function if not diagnosed and treated appropriately. For these injuries in general, even after a diagnosis is made, treatment options are controversial and become even more so in high level athletes where limiting the time away from training and competition is a significant consideration.

In this review, we cover some of the common and important sporting injuries affecting the foot including updates on their management and outcomes.

Cite this article: Bone Joint J 2016;98-B:1299–1311.