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The Bone & Joint Journal
Vol. 100-B, Issue 4 | Pages 468 - 474
1 Apr 2018
Kirzner N Zotov P Goldbloom D Curry H Bedi H

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.

Patients and Methods

A total of 108 patients were treated for a Lisfranc fracture dislocation over a period of nine years. Of these, 38 underwent transarticular screw fixation, 45 dorsal bridge plating, and 25 a combination technique. Injuries were assessed preoperatively according to the Myerson classification system. The outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) score, the validated Manchester Oxford Foot Questionnaire (MOXFQ) functional tool, and the radiological Wilppula classification of anatomical reduction.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_21 | Pages 2 - 2
1 Dec 2017
Agarwal S Iliopoulos E Khaleel A
Full Access

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.

Materials and methods

22 patients with a minimum follow up of 12 months were included. We achieved satisfactory anatomical reduction percutaneously in all patients and internal fixation was performed using cannulated screws for medial and middle columns. Functional outcome was evaluated using Foot and Ankle Disability Index (FADI) and components of this score were analysed individually to assess which domain was most affected. Vertical ground reaction forces were measured using a force plate in a walking platform.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_13 | Pages 5 - 5
17 Jun 2024
Aamir J Caldwell R Karthikappallil D Tanaka H Elbannan M Mason L
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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


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_14 | Pages 4 - 4
1 Dec 2015
Walter R Trimble K Westwood M
Full Access

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


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXII | Pages 6 - 6
1 May 2012
Saltzman C
Full Access

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?


The Bone & Joint Journal
Vol. 101-B, Issue 4 | Pages 447 - 453
1 Apr 2019
Sanders FRK Backes M Dingemans SA Hoogendoorn JM Schep NWL Vermeulen J Goslings JC Schepers T

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.

Patients and Methods

All adult patients (18 to 75 years) undergoing IR after fracture fixation below the level of the knee between November 2014 and September 2016 were included as part of the WIFI (Wound Infections Following Implant Removal Below the Knee) trial, performed in 17 teaching hospitals and two university hospitals in The Netherlands. In this multicentre prospective cohort, the primary outcome was the difference in functional status before and after IR, measured by the Lower Extremity Functional Scale (LEFS), with a minimal clinically important difference of nine points.


The Bone & Joint Journal
Vol. 98-B, Issue 10 | Pages 1299 - 1311
1 Oct 2016
Hong CC Pearce CJ Ballal MS Calder JDF

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.