Diagnosis Of Lisfranc Injuries Research Articles

Cost comparison and complication rate of Lisfranc injuries treated with open reduction internal fixation versus primary arthrodesis

BackgroundControversy exists regarding optimal primary management of Lisfranc injuries. Whether open reduction internal fixation (ORIF) or primary arthrodesis is superior remains unknown. MethodsA national insurance database of approximately 23.5 million orthopedic patients was retrospectively queried for subjects who were diagnosed with a Lisfranc injury from 2007 to 2016 based on international classification of diseases (ICD) codes (PearlDiver, Colorado Springs, CO). Patients with lisfranc injuries then progressed to either nonoperative treatment, ORIF, or primary arthrodesis. Associated treatment costs were determined along with complication rate and hardware removal rate. Results2205 subjects with a diagnosis of Lisfranc injury were identified in the database. 1248 patients underwent nonoperative management, 670 underwent ORIF, and 212 underwent primary arthrodesis. The average cost of care associated with primary arthrodesis was greater ($5005.82) than for ORIF ($3961.97,P = 0.045). The overall complication rate was 23.1% (155/670) for ORIF and 30.2% (64/212) for primary arthrodesis (P = 0.04). Rates of hardware removal were 43.6% (292/670) for ORIF and 18.4% (39/212) for arthrodesis (P < 0.001). Furthermore, 2.5% (17/670) patients in the ORIF group progressed to arthrodesis at a mean of 308 days, average cost of care associated with this group of patients was $9505.12. DiscussionPrimary arthrodesis is both significantly more expensive and has a higher complication rate than ORIF. Open reduction and internal fixation demonstrated a low rate of progression to arthrodesis, although there was a high rate of hardware removal, which may represent a planned second procedure in the management of a substantial number of patients treated with ORIF. Level of evidence:Level III Retrospective Cohort Study.

Cost Comparison and Complication Rate of Lisfranc Injuries Treated with Open Reduction Internal Fixation versus Primary Arthrodesis

Category: Midfoot/Forefoot Introduction/Purpose: Controversy exists regarding optimal primary management of Lisfranc injuries. Whether open reduction internal fixation or primary arthrodesis is superior remains unknown. Our retrospective study uses a private payer database to compare cost, complication rate, and hardware removal rate in Lisfranc injuries treated with primary open reduction internal fixation or primary arthrodesis. Methods: Utilizing data mining software created by a private organization, a national insurance database of approximately 23.5 million orthopedic patients was retrospectively queried for subjects who were diagnosed with a Lisfranc injury from 2007-2016 based on international classification of diseases (ICD) codes for tarsometatarsal (TMT) dislocation (PearlDiver, Colorado Springs, CO). Patients with TMT dislocations then progressed on to either non-operative treatment, open reduction internal fixation, or primary arthrodesis. Treatment costs based on diagnosis codes were followed after initial diagnosis and t-tests were used to determine statistical significance. Subgroups were created based on having at least one complication ICD or current procedural terminology (CPT) code after the beginning of treatment, which included: hemorrhage, infection, nonunion, malunion, thromboembolism, wound and hardware complications, or amputation. Additionally, patients undergoing implant removal were identified by CPT code for removal of hardware performed after the index procedure. Complication and hardware removal rates were compared with chi-square test. Results: 2205 subjects with a diagnosis of Lisfranc injury were identified in the database. 1248 patients underwent non-operative management, 670 underwent open reduction internal fixation, and 212 underwent primary arthrodesis. The average cost of care associated with primary arthrodesis was greater ($5,005.82) than for open reduction internal fixation ($3,961.97, P=0.045). The overall complication rate was 23.1% (155/670) for open reduction internal fixation and 30.2% (64/212) for primary arthrodesis (P=0.04). Rates of hardware removal independent of complications were 43.6% (292/670) for open reduction internal fixation and 18.4% (39/212) for arthrodesis (P&lt;0.001). Furthermore, 2.5% (17/670) patients in the open reduction internal fixation group progressed to arthrodesis at a mean of 308 days, average cost of care associated with this group of patients was $9,505.12. Conclusion: Primary arthrodesis for the management of acute Lisfranc injuries is both significantly more expensive and has a higher complication rate than open reduction internal fixation. Open reduction internal fixation demonstrated a low rate of progression to arthrodesis, although there was a high rate of hardware removal, which may represent a planned second procedure in the management of a substantial number of patients treated with open reduction internal fixation.

Cost Comparison and Complication Rate of Lisfranc Injuries Treated with Open Reduction Internal Fixation versus Primary Arthrodesis

Objectives:Controversy exists regarding optimal primary management of Lisfranc injuries. Whether open reduction internal fixation or primary arthrodesis is superior remains unknown. Our retrospective study uses a private payer database to compare cost, complication rate, and hardware removal rate in Lisfranc injuries treated with primary open reduction internal fixation or primary arthrodesis.Methods:Utilizing data mining software created by a private organization, a national insurance database of approximately 23.5 million orthopedic patients was retrospectively queried for subjects who were diagnosed with a Lisfranc injury from 2007-2016 based on international classification of diseases (ICD) codes for tarsometatarsal (TMT) dislocation (PearlDiver, Colorado Springs, CO). Patients with TMT dislocations then progressed on to either non-operative treatment, open reduction internal fixation, or primary arthrodesis. Associated treatment costs based on diagnosis codes were followed after initial diagnosis and t-tests were used to determine statistical significance. Subgroups were then created based on having at least one complication ICD or current procedural terminology (CPT) code after the beginning of treatment, which included: hemorrhage, infection, nonunion, malunion, thromboembolism, wound and hardware complications, or amputation. Additionally, patients undergoing implant removal were identified by CPT code for removal of hardware performed after the index procedure. Complication and hardware removal rates were compared with chi-square test.Results:2205 subjects with a diagnosis of Lisfranc injury were identified in the database. 1248 patients underwent non-operative management, 670 underwent open reduction internal fixation, and 212 underwent primary arthrodesis. The average cost of care associated with primary arthrodesis was greater ($5,005.82) than for open reduction internal fixation ($3,961.97, P=0.045). The overall complication rate was 23.1% (155/670) for open reduction internal fixation and 30.2% (64/212) for primary arthrodesis (P=0.04). Rates of hardware removal independent of complications were 43.6% (292/670) for open reduction internal fixation and 18.4% (39/212) for arthrodesis (P<0.001). Furthermore, 2.5% (17/670) patients in the open reduction internal fixation group progressed to arthrodesis at a mean of 308 days, average cost of care associated with this group of patients was $9,505.12.Conclusion:Primary arthrodesis for the management of acute Lisfranc injuries is both significantly more expensive and has a higher complication rate than open reduction internal fixation. Open reduction internal fixation demonstrated a low rate of progression to arthrodesis, although there was a high rate of hardware removal, which may represent a planned second procedure in the management of a substantial number of patients treated with open reduction internal fixation.

Gravity Stress Radiograph Revealing Instability at the First Metatarso-Cuneiform Joint in Lisfranc Injury

Lisfranc injuries are commonly missed in the acute setting, largely due to subtle findings that often require weightbearing radiographs or more complex imaging for diagnosis. The long-term consequences of missed injuries are debilitating osteoarthritis of the midfoot, but this may be prevented with appropriate diagnosis and treatment. This case study presents a Lisfranc injury initially diagnosed by gravity stress radiograph. While used for other injuries, there is no literature on the use of gravity stress radiographs for diagnosis of Lisfranc injuries. The use of this simple technique to accurately diagnose Lisfranc injuries may improve detection and patient outcomes.

Ecchymosis on the Plantar Side of the Foot

Although the incidence of Lisfranc injuries is not high, they are related to long-term disability of the foot such as malalignment, functional deficits and weight bearing difficulties. Delayed treatment or missed diagnosis of Lisfranc injuries can result in significant complications. Lisfranc injuries result from both indirect and direct trauma. A 43 years old man came into the emergency with pain in his right foot after a direct trauma to the anterior part of his foot while playing soccer.Introduction Lisfranc injuries are relatively uncommon, representing approximately 0.2% of all fractures. Although the incidence of Lisfranc injuries is not high, they are related to long-term disability of the foot such as malalignment, functional deficits and weight bearing difficulties [1]. Delayed treatment or missed diagnosis of Lisfranc injuries can result in significant complications.

The Diagnostic Accuracy of Radiographs in Lisfranc Injury and the Potential Value of a Craniocaudal Projection

The purpose of this study is to determine the diagnostic accuracy of radiographs in the diagnosis of Lisfranc injury. In addition, a foot phantom was investigated to determine the optimum degree of craniocaudal angulation on the anteroposterior radiograph to best show the joint. The angle of the joint in patients with midfoot injury was investigated to determine the optimum degree of craniocaudal angulation. Sixty patients examined by CT had their radiographs evaluated independently and by consensus opinion by two observers, and the diagnostic performance was calculated using CT as the reference standard. A foot phantom was radiographed with varying degrees of craniocaudal angulation, and the radiograph that best revealed the joint was determined. This was compared with the angle of the joint as measured on CT. The angle of the joint in all 60 patients was measured on CT. The radiographs correctly identified 31 of the 45 cases (68.9%) of Lisfranc injury, with a positive predictive value of 84.4%, a negative predictive value of 53.3%, a sensitivity of 84.4%, and a specificity of 53.3%. Twenty degrees of craniocaudal angulation best showed the second tarsal-metatarsal joint of the phantom, and this correlated with a 20° angle measured by CT. The mean (± SD) angle of the joint in the patients was 28.9° ± 5.7°. Conventional radiographs miss a significant number of cases of Lisfranc injury. Craniocaudal angulation can better show the joint, and an angle of 28.9° is likely to optimally visualize the joint in the majority of patients.

The diagnostic accuracy of plain radiographs in Lisfranc injury and the potential value of a cranial caudal projection.

Purpose: To determine the diagnostic accuracy of plain radiographs in the diagnosis of Lisfranc injury. In addition a foot phantom was investigated to determine the optimum degree of cranio-caudal angulation on the AP radiograph to best demonstrate the joint. The angle of the joint in patients with mid-foot injury was investigated to determine the optimum degree of cranio-caudal angulation required.

Management of a Stage III Lisfranc Ligament Injury in a Collegiate Football Player

The diagnosis and management of the Lisfranc joint injury is a complicated and sometimes frustrating endeavor. Some con- sensus exists on the diagnosis of Lisfranc injuries; however, the proper management of these subtle injuries is still debated and poorly reported. This case review highlights a unique manage- ment of a stage III Lisfranc injury, in that the athlete was able to successfully return to full participation after 3 weeks of rest and conservative, nonsurgical treatment.

Bone Scintigraphy Findings in Lisfranc Joint Injury

Three-phase bone scintigraphy diagnosis of Lisfranc injury in a patient after foot trauma is discussed. Early diagnosis of Lisfranc joint injury is frequently missed and radionuclide bone scintigraphy may show a specific pattern where the x-rays are inconclusive.