American Orthopaedic Foot And Ankle Society Midfoot Score Research Articles

Primary Arthrodesis Versus Open Reduction and Internal Fixation Outcomes for Lisfranc Injuries: An Analysis of Conflicting Meta-analyses Results.

The superiority of primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in Lisfranc injuries has been debated. Meta-analyses comparing these surgical options have reached contradicting conclusions. The goal of this article is to determine why different conclusions were reached and provide clarity on the comparable outcomes of PA and ORIF in Lisfranc injuries. A systematic literature review was conducted by searching for "meta-analysis" AND "Lisfranc" with keywords such as "ORIF" OR "open reduction" OR "arthrodesis" OR "fusion." Five meta-analysis articles discussing PA and ORIF in Lisfranc injuries were identified. Study outcomes were extracted from each article, and contradicting conclusions were identified for analysis. PA had lower rates of hardware removal. There was no difference between PA and ORIF when considering revision surgery, anatomic reduction, postoperative infection, total complications, and patient satisfaction. However, contradicting conclusions were reached for return to duty, the American Orthopaedic Foot and Ankle Society (AOFAS) score, and visual analogue scale (VAS) score. Conclusions. There was no difference in PA and ORIF for return to work and VAS score. Repeat meta-analysis with truly equivocal outcomes would be necessary to reach a valid conclusion for return to full activity and AOFAS midfoot scores. Level II: Therapeutic studies.

Functional outcomes of traumatic midfoot injuries

IntroductionMidfoot injuries are rare injuries, often the result of high-energy trauma and occurring in the context of multiple trauma. This study aimed to evaluate functional outcomes and health-related quality of life after open reduction and internal fixation for midfoot injuries at a level 1 trauma center treating complex foot injuries. MethodsRetrospective single level 1 center study with follow-up by questionnaire. All adult patients who underwent open reduction and internal fixation (ORIF) for Lisfranc and/or Chopart injuries between 2000 and 2016 were included and invited to complete the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score, the EuroQOL Visual Analog Scale (EQ-VAS), and the EuroQOL five-dimensional questionnaire (EQ-5D-5L). Chart reviews were performed to collect demographic, injury, and treatment characteristics. ResultsForty patients with 45 midfoot injuries were included. Follow-up was available for 29 patients (31 feet), leading to a response rate of 83%. The majority of patients suffered high-energy trauma and nearly all patients had a concomitant injury. Secondary arthrodesis was performed in 7/45 injuries. Median AOFAS score was 64 (IQR 47–78). Higher injury severity score (ISS) was associated with poorer functionality as measured with the AOFAS Midfoot Score (p = 0.046), concomitant injuries were associated with lower quality of life (p = 0.01). EQ-5D scores were significantly lower when compared to the Dutch reference population (p< 0.001). ConclusionsInjuries of the midfoot have negative effects on mid- to long-term quality of life after trauma, with considerable potential for long-term impaired functionality. When counseling patients with these rare injuries after high-energy trauma mechanisms or in the context of multiple trauma, realistic expectations on postoperative recovery should be given.

Results of operative correction of grade IIB tibialis posterior tendon dysfunction.

The prevalence of tibialis posterior tendon dysfunction (PTTD) is estimated to be as high as 3% to 4% in Western populations, and it is one of the most commonly misdiagnosed conditions of the foot and ankle. Clinical and radiological outcomes were assessed in grade IIB PTTD treated with a medializing calcaneal osteotomy, lateral column lengthening, flexor digitorum longus transfer, and tendo-Achilles lengthening. The clinical and radiological findings recorded were the SF-36 score on physical function and mental health, midfoot and hindfoot American Orthopaedic Foot and Ankle Society (AOFAS) clinical scores, the midfoot and visual analog pain scores, as well as the radiological measurements of the hindfoot calcaneal pitch, talo-first metatarsal angle, and medial cuneiform height. The time points of assessment were preoperatively, 6 months postoperatively, and 24 months postoperatively by an examiner different from the operating surgeon. The SF-36 score on physical function (mean difference of 8.7 and 8.2, respectively), AOFAS midfoot score (mean difference of 29.6 and 15.3, respectively), AOFAS ankle-hindfoot score (mean difference of 23.2 and 14.3, respectively), midfoot visual analog pain score (mean difference of 4.0 and 1.2), and the ankle and hindfoot visual analog score (mean difference of 3.6 and 1.6) all had significant reduction from the preoperative to the 24-month postoperative time point (P < .001). Radiologically, there was also correction of the deformity associated with PTTD. The hindfoot calcaneal pitch was corrected from 8.4 degrees to 18.7 degrees. The talo-first metatarsal angle was corrected from 14.0 degrees to 1.3 degrees, and the medial cuneiform height was corrected from 10.3 mm to 20.4 mm at 24 months postoperatively. Grade IIB PTTD treated with a medializing calcaneal osteotomy, lateral column lengthening, flexor digitorum longus transfer, and tendo-Achilles lengthening demonstrated statistical significant improvement in hindfoot and midfoot AOFAS scores, SF-36 physical function scores, as well as visual analog scores. The complications were minimal. We advocate the combination of these procedures as being successful for the treatment of grade IIB PTTD. Longer term follow-up is needed to determine if these improvements plateau, improve, or deteriorate. Level IV, retrospective case series.

Analysis of Clinical Outcome and Prognosis for Lisfranc Joint Fracture and Dislocation according to the Injury Mechanism and Treatment Method

Purpose: The purpose of this study was to assess the treatment outcomes and prognosis of Lisfranc joint fracture and dislocation according to the mechanism of injury and treatment method. Materials and Methods: Twenty six patients with Lisfranc fracture-dislocation who had been treated surgically were included in this retrospective study. The patients were divided into two groups according to mechanism of injury: direct crushing injury (16 patients) and indirect rotational or compressive injury (10 patients). The patients were also divided into three groups according to the surgical methods. The parameters used were radiographic evaluation, patients’ subjective satisfaction levels, length of hospital stay, and the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score. Statistical analysis was performed. Results: The mean postoperative AOFAS midfoot score was 78.7. The mean length of stay was 39.6 days. Statistically significant differences in subjective satisfaction, AOFAS midfoot score, and length of hospital stay were observed between the two groups (p 0.05). Conclusion: Mechanism of trauma and the severity of soft-tissue injury were significant prognostic factors affecting the surgical outcomes of Lisfranc joint fracture and dislocation.

LCP distal ulna hook plate as alternative fixation for fifth metatarsal base fracture

Intramedullary screw fixation is the most common treatment for fifth metatarsal base fractures. Screw application does not achieve accurate reduction in fracture with small fragments, osteoporotic bone, or Lawrence zone 1 fractures, however. On the basis of similar anatomical architectures between the distal ulna and the fifth metatarsal base, the purpose of this study was to assess the results of a locking compression plate (LCP) distal ulna hook plate in stabilizing displaced zone 1 or 2 fifth metatarsal base fractures. Nineteen patients with Lawrence zone 1 (n=12) or 2 (n=7) fractures of the fifth metatarsal base were treated surgically with an LCP distal ulna hook plate. The patients were evaluated clinically and radiographically, and functional outcomes were graded by using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system. Radiographic bony union was obtained in all patients, at an average of 7.4weeks. The mean AOFAS midfoot score improved from 26 (range, 0-45) preoperatively to 94 (range, 72-100) points at the final follow-up. There were three patients with post-traumatic cubometatarsal arthrosis and one patient with sural nerve neuropraxia. In our experience, the distal ulna hook plate achieves a high rate of bony consolidation and anatomically suitable fixation in zone 1 or 2 fifth metatarsal base fractures. We also suggest that the LCP distal ulna hook plate should be considered as an alternative treatment in multifragmentary, osteoporotic, and tuberosity avulsion (zone 1) fifth metatarsal base fractures.

Treatment of Severe, Painful Pes Planovalgus Deformity with Hindfoot Arthrodesis and Wedge-Shaped Tricortical Allograft

This study tested the hypothesis that modification of the standard technique of hindfoot arthrodesis with the use of a wedge-shaped tricortical allograft would improve the amount of correction of pes planovalgus deformity. The results were compared to previous reports. Between 1998 and 2005, the senior author (LBC) performed 13 hindfoot arthrodeses on 12 patients using an allograft to improve correction of the deformity for severe, painful pes planovalgus deformity. The average patient age was 55 (range 27 to 77) years. There were seven women and five men. The indications were posterior tibial tendon dysfunction (seven feet), rheumatoid arthritis (three feet), post-traumatic arthritis and deformity (one foot), congenital pes planovalgus (one foot), and tarsal coalition (one foot). Twelve of 13 feet achieved union by 12 weeks postoperatively. There was one nonunion. The average time to fusion was 12 weeks. All 12 patients were satisfied with the results of the operation. The average postoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was 87 points, and the AOFAS Midfoot score was 85 points. Preoperative and postoperative radiographs were compared to evaluate correction of deformity. On lateral weightbearing views, the talo-first metatarsal angle improved from 15 to 6 degrees, and the lateral talocalcaneal angle improved from 48 to 35 degrees. On anteroposterior views, the talo-first metatarsal angle improved from 17 to 7 degrees, the talonavicular coverage decreased from 28 to 13 degrees, and the talocalcaneal angle improved from 23 to 13 degrees. A simple modification of the addition of allograft to a common procedure of hindfoot arthrodesis to treat severe, painful pes planovalgus results is reliable and offers satisfactory correction.