Ankle Society Midfoot Score Research Articles

Bioabsorbable Screws for Reduction of Lisfranc’s Diastasis in Athletes

This was a study of 15 athletes who sustained Lisfranc's diastasis and were treated with surgical reduction and fixation with 3.5mm bioabsorbable poly-L lactic acid screws. Patients were prospectively evaluated for their ability to return to activity, maintenance of reduction, and need for implant removal. The average patient age was 28 years; there were 9 females and 6 males. Average followup was 36 months (range: 12-62). The mean return to activity time was 4.2 months (range: 3-6), with a significant difference between males and females (P=.02), 3.4 versus 4.7 months, respectively. The mean preoperative American Orthopedic Foot and Ankle Society midfoot score was 35.4+/-25.0, which increased postoperatively to 92.7+/-7.7 (P=.00001). Overall there were 10 "excellent," 4 "good," and 1 "poor" result. Patients were statistically more likely to have less than an excellent result when diagnosis was delayed by more than 6 weeks (P=0.01). One patient demonstrated a radiographic loss of reduction but returned to full sports activities. The patient with the longest delay in diagnosis demonstrated anatomic reduction but exhibited radiographic degenerative changes and scored a poor result. Three patients required a second surgery for screw or screw head removal. Bioabsorbable screws appear sufficient for treating Lisfranc's diastasis but do not necessarily obviate fixation removal.

Chopart joint fracture-dislocation: initial open reduction provides better outcome than closed reduction.

Injury cause, treatment, and long-term results [American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score, Hannover Scoring System, Hannover Outcome Questionnaire] of patients with Chopart joint dislocations or fracture-dislocations were evaluated. Between 1972 and 1997, 100 patients with 110 Chopart joint dislocations were treated in the authors' institution. Pure Chopart joint dislocations were observed in 28 (25%) feet, fracture-dislocations in 60 (55%) feet, and combined Chopart-Lisfranc joint fracture-dislocations in 22 (20%) feet. The primary treatment was operative in 91 (83%) feet and nonoperative in 19 (17%) feet. Sixty-five (65%) patients had follow-up after an average of 9 years (range, 2-25 years). The mean scores of the entire follow-up group were: AOFAS score, 75 points; Hannover Scoring System, 69 points (maximium possible score = 100 points); Hannover Outcome Questionnaire, 68 points (maximium possible score = 100 points). There were no differences between the scores for pure dislocations or fracture-dislocations of the Chopart joint, but significantly lower scores were noted with combined Chopart-Lisfranc joint fracture-dislocations. In all three injury pattern groups, an initial anatomic reduction was essential for good results. The high functional restrictions in Chopart dislocations can most likely be minimized with initial open reduction, especially in fracture-dislocations. A closed reduction yielded good results only with pure dislocations, when anatomic conditions could be restored, or if there were contraindications to surgery.

Outcome after anatomic reduction and transfixation with Kirschner wires of Lisfranc joint injuries

Injuries to the tarsometatarsal (Lisfranc) joint are uncommon, and the results of treatment are often unsatisfactory. Open reduction and internal fixation has been recommended as the treatment of choice for most unstable injuries. In the present study, we reviewed 16 patients who underwent closed or open reduction and Kirschner-wire transfixation of a Lisfranc injury in an 11-year period. Mean follow-up was 44 (range, 12–108) months. Average American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score was 78 (range, 45–100) points. Eight patients (50%) developed posttraumatic arthritis of the tarsometatarsal joints. The major cause was nonanatomical reduction, whereas patients with purely ligamentous injury showed a trend toward poorer postoperative outcome. On the basis of our study, open anatomical reduction of fracture-dislocations of the Lisfranc joint and Kirschner-wire transfixation leads to the best long-term outcome.

Outcome after open reduction and internal fixation of Lisfranc joint injuries.

Open reduction and internal fixation has been recommended as the treatment for most unstable injuries of the Lisfranc (tarsometatarsal) joint. It has been thought that purely ligamentous injuries have a poor outcome despite such surgical management. We performed a retrospective study of patients who underwent open reduction and screw fixation of a Lisfranc injury in a seven-year period. Among ninety-two adults treated for that injury, forty-eight patients with forty-eight injuries were followed for an average of fifty-two months (range, thirteen to 114 months). Fifteen injuries were purely ligamentous, and thirty-three were combined ligamentous and osseous. Patient outcome was assessed with use of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and the long-form Musculoskeletal Function Assessment (MFA) score. The average AOFAS midfoot score was 77 points (on a scale of 0 to 100 points, with 100 points indicating an excellent outcome), with patients losing points for mild pain, decreased recreational function, and orthotic requirements. The average MFA score was 19 points (on a scale of 0 to 100 points, with 0 points indicating an excellent outcome), with patients losing points because of problems with "leisure activities" and difficulties with "life changes and feelings due to the injury." Twelve patients (25 percent) had posttraumatic osteoarthritis of the tarsometatarsal joints, and six of them required arthrodesis. The major determinant of a good result was anatomical reduction (p = 0.05). The subgroup of patients with purely ligamentous injury showed a trend toward poorer outcomes despite anatomical reduction and screw fixation. Our results support the concept that stable anatomical reduction of fracture-dislocations of the Lisfranc joint leads to the best long-term outcomes as patients so treated have less arthritis as well as better AOFAS midfoot scores.