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

Purpose:. To describe a plating technique for the Lapidus procedure as an alternative to the traditional screw fixation technique. To look at the complications experienced during the Lapidus procedure and to find possible solutions to prevent these complications. Methods:. A retrospective study of 34 Lapidus procedures in 26 patients (8 bilateral) between 2006 and 2009 was performed. All were done with a plating technique and a primary bone graft. The indications were:. metatarsus primus varus. hypermobility. degenerative TMT joint. Results:. The average intermetatarsal angle pre-operatively was 17.1° and this was reduced to 6,4° post – operatively. The complications experienced were:. post –operative metal removal = 6. transfer metatarsalgia = 1. hallux varus = 1. screw breakage = 1. delayed union = 1. non-union = 1. Conclusion:. The plating technique for the Lapidus procedure gives stable fixation and the outcome compares well with other methods of fixation

Introduction. Surgical approaches to the dorsum of the foot are common for management of midfoot fracture dislocations and arthritis. The anatomy can be difficult to identify and neurovascular injury can be a serious complication. Extensor hallucis brevis (EHB) is a consistent and easily identifiable structure encountered in these approaches. This study assesses the close relationship of the EHB musculotendinous junction to the neurovascular bundle for use as a reliable landmark. Method. The relationship of the medial branch of the deep peroneal nerve (DPN) in the dorsum of the foot to the EHB tendon was examined by dissection of ten adult cadaveric feet preserved in formalin. Using a dorsal approach, the anatomy of the DPN neurovascular bundle was studied relative to its neighbouring structures. Local institutional review board approval was obtained. Results. The neurovascular bundle runs parallel to the lateral border of extensor hallucis longus (EHL) over the dorsum of the midfoot. Lateral to the neurovascular bundle is the EHB muscle running obliquely towards the first metatarsal. The average length of transition of the musculotendinous junction is 11mm and the neurovascular bundle passes underneath this junction in nine out of ten cases, and through it in one specimen. This junction is directly over the 2. nd. tarsometatarsal joint. Discussion. Although a cadaveric study where tissue characteristics are different to those of living tissue, this study has shown that the neurovascular bundle with the medial branch of the deep peroneal nerve and corresponding artery can be identified by finding the musculotendinous junction of the EHB

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