Treatment Of Lisfranc Injuries Research Articles

Efficacy comparison of dorsal approach and medical approach in treating Lisfranc injury

Objective: To compare the efficacy of dorsal approach and medial approach in the treatment of Lisfranc injury. Methods: A retrospective cohort study was conducted to analyze the clinical data of 43 patients with closed Lisfranc injuries admitted to Tongji Hospital of Tongji University from January 2017 to December 2021. The surgical approach were open reduction and internal fixation or metatarsal cuneiform joint fusion, with 23 cases using the dorsal approach and 20 cases using the medial approach. The duration of surgery, incisional complications, loss of internal fixation, internal fixation removal rate, patient's clinical satisfaction, and American Orthopedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score of pain in the patients were reviewed based on the medical record system and follow-up records. Results: Of the patients, 33 were male and 10 were female, with a mean age of (45.2±13.4) years. All the patients were followed up for (17.9±6.7) months, and there was no statistically significant differences in the baseline data between the two groups. Preoperatively, the dorsal approach group and the medial approach group had a AOFAS score of (30.3±10.7) and (28.5±9.3), respectively, and a VAS score of (6.2±1.9) and (6.3±2.1), respectively (both P>0.05); the operation time was (112.2±25.0) min and (91.0±22.5) min, respectively in the two groups (P=0.006). Two patients in the dorsal approach group developed superficial infection in the incision, one patient experienced delayed healing in the medial approach group, while the remaining patients achieved primary healing. In the dorsal approach group, three patients suffered long-term numbness or pain on the dorsum of the foot during follow-up, which was alleviated with neurotrophic medications; in the medial approach group, one patient had abnormal sensations around the wound site, which gradually improved. During the follow-up period, a total of 10 patients underwent internal fixation removal, including 7 patients (30.4%) in the dorsal approach group and 3 patients (15.0%) in the medial approach group (P=0.294). The AOFAS score in the dorsal approach group and the medial approach group at the last follow-up was 83.8±7.7 and 86.7±6.9 (P=0.207), and the VAS scores was 2.1±1.0 and 1.3±0.5 (P=0.002), respectively, both showed improvement when compared with those before the surgery (both P<0.001). In both groups, the internal fixations were all in place, with no cases of lost implants. In the dorsal approach group, 3 patients (13.0%) were dissatisfied with the surgical outcome, while in the medial approach group, 1 patient (5%) was dissatisfied (P=0.848). Conclusions: Both surgical approaches resulted in a good prognosis, and there is no statistical difference between the two groups in terms of fixation effect, and the medial approach group is superior to the dorsal access in operative time, internal fixation removal rate, VAS score and patient clinical satisfaction.

Primary Arthrodesis or Open Reduction and Internal Fixation for Lisfranc Injuries: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Lisfranc injuries are often managed surgically with primary arthrodesis (PA) or open reduction and internal fixation (ORIF); however, neither approach has been shown to be superior. This systematic review and meta-analysis assessed randomized controlled trials (RCTs) to compare the functional and surgical outcomes of PA and ORIF in the treatment of Lisfranc injuries. This study was performed as per the PRISMA protocol. Database searches were conducted on Cochrane, Embase, and PubMed libraries. Five RCTs were identified for inclusion involving 241 patients, of which 121 underwent PA and 120 underwent ORIF. Statistically significant differences in visual analog scale pain score at 2 years (mean difference 0.89, 95% CI 0.18-1.59), patient satisfaction (OR 10.04, 95% CI 1.78-56.76), and all-cause return to surgery (OR 27.31, 95% CI 12.72-58.63) were observed, all favoring PA. There were no statistically significant differences between PA and ORIF with regard to American Orthopaedic Foot & Ankle Society midfoot scores at 2 years, 36-Item Short Form Health Survey (SF-36) scores, and unplanned return to surgery. This study showed significant improvement in pain at 2 years, patient satisfaction, and all-cause return to surgery favoring PA in all instances. Given ORIF often necessitates a second operation for hardware removal, it is to be expected that all-cause return to surgery is higher in ORIF groups. Overall, these results do not have the power to confer an advantage to a particular approach because of significant heterogeneity. Further studies should focus on larger patient cohorts and longer follow-up, or analysis stratified by patient demographics and injury presentation. In the absence of clinically significant differences, cost-benefit analyses should be considered to answer the question of whether to "fix or fuse" for Lisfranc injuries.

Evaluating plate fixation outcomes in the treatment of Lisfranc injuries

Evaluating plate fixation outcomes in the treatment of Lisfranc injuries

Outcome of Plate Fixation in Treatment of Lisfranc Injuries

Outcome of Plate Fixation in Treatment of Lisfranc Injuries

Meta-analysis of the effect of hollow nail and bone plate on Lisfranc injury

To compare the clinical efficacy of screw and bone plate internal fixation in the treatment of Lisfranc injury. The databases of Wanfang, CNKI, Pubmed, EMBASE, VIP, BIOSIS and other databases were retrieved by computer, and the clinical trial literature from January 1, 2000 to August 1, 2021 was retrieved, the methodological quality of the included studies was strictly evaluated and the data were extracted, and the obtained data were meta-analyzed by Revman 5.4 software. Nine randomized controlled trial literature and 10 retrospective cohort studies were included, of which 416 patients in the experimental group were treated with screw internal fixation, and 435 patients in the control group were treated with bone plate internal fixation. Meta-analysis showed that the surgical time of the bone plate internal fixation group was longer than that of the screw internal fixation group [MD=-14.40, 95%CI(-17.21, -11.60), P<0.000 01], the postoperative X-ray anatomical reduction of the bone plate internal fixation group [MD=0.47, 95%CI(0.25, 0.86), P=0.01], the excellent and good rate of postoperative American orthopedic foot and ankle society(AOFAS) foot function score[MD=0.25, 95%CI(0.15, 0.42), P<0.000 01], postoperative AOFAS foot function score [MD=-5.51, 95%CI(-10.10, -0.92), P=0.02] of the bone plate fixation group was better than those of the screw internal fixation group. Two kinds of operation method had no statistical different for postoperative fracture healing time[MD=1.91, 95%CI(-1.36, 5.18), P=0.25], postoperative visual analgue scale(VAS)[MD=0.38, 95%CI(0.09, 0.86), P=0.11], postoperative complications [MD=1.32, 95%CI(0.73, 2.40), P=0.36], the postoperative infection [MD=0.84, 95%CI(0.48, 1.46), P=0.53], the postoperative fracture internal fixation loosening [MD=1.25, 95% CI(0.61, 2.53), P=0.54], the postoperative incidence of traumatic arthritis [MD=1.80, 95%CI(0.83, 3.91), P=0.14]. Bone plate fixation has better short-term and medium-term results and lower reoperation rate in the treatment of Lisfranc injury, so it is recommended to use bone plate fixation in the treatment of Lisfranc injury.

Retrospective analysis of treatment decisions and clinical outcome of Lisfranc injuries: operative vs. conservative treatment

PurposeLisfranc injuries are rare and often pose a challenge for surgeons, particularly in initially missed or neglected cases. The evidence on which subtypes of Lisfranc injuries are suitable for conservative treatment or should undergo surgery is low. The aim of this study was to retrospectively analyze treatment decisions of Lisfranc injuries and the clinical outcome of these patients within the last ten years.MethodsAll patients treated due to a Lisfranc injury in a German level I trauma centre from January 2011 until December 2020 were included in this study. Radiologic images and medical data from the patient files were analyzed concerning the classification of injury, specific radiologic variables, such as the Buehren criteria, patient baseline characteristics, and patient outcome reported with the Foot Function Index (FFI).ResultsNinety-nine patients were included in this study (conservative = 20, operative = 79). The overall clinical outcome assessed by the FFI was good (FFI sum 23.93, SD 24.93); patients that were identified as suitable for conservative treatment did not show inferior functional results. Qualitative radiological factors like the grade of displacement and the trauma mechanism were more strongly associated with the decision for surgical treatment than quantitative radiologic factors such as the distance from the first to the second metatarsal bone.ConclusionIf the indication for conservative or operative treatment of Lisfranc injuries is determined correctly, the clinical outcome can be comparable. These decisions should be based on several factors including quantitative and qualitative radiologic criteria, as well as the trauma mechanism.

Optimizing Return to Play for Common and Controversial Foot and Ankle Sports Injuries.

Surgical decision-making should consider factors to help optimize return to play for athletes with foot and ankle injuries, including injuries to the syndesmosis, the Achilles tendon, the fifth metatarsal, and the Lisfranc complex. Understanding influential factors on return to play may help orthopaedic surgeons counsel athletes and coaches on expectations for a timeline to return to play and performance metrics. Outcomes after rigid and flexible fixation for syndesmotic injuries are generally favorable. Some data support an earlier return to sport and higher functional scores with flexible fixation, in addition to lower rates of reoperation and a decreased incidence of malreduction, particularly with deltoid repair, if indicated. Minimally invasive techniques for Achilles tendon repair have been shown to have a decreased risk of wound complications. Athletes undergoing Achilles repair should expect to miss a full season of play to recover. Athletes with fifth metatarsal fractures have better return-to-play outcomes with surgical management and can expect a high return-to-play rate within approximately 3 months of surgery. Percutaneous treatment of Lisfranc injuries may expedite return to play relative to open procedures.

Treatment of Lisfranc Injuries Using Interosseous Suture Button: A Retrospective Review of 84 Cases With a Minimum 3-Year Follow-Up

Lisfranc fracture dislocation is an injury often encountered by the foot and ankle surgeon. This injury, depending on the severity and level of energy, has been shown to lead to posttraumatic osteoarthritis and chronic pain if undiagnosed or improperly managed. The purpose of this study was to retrospectively evaluate the surgical repair with the use of an interosseous suture button for Lisfranc injuries with isolated ligamentous disruption. From 2008 through 2016, 104 patients were consecutively enrolled who underwent open reduction internal fixation (ORIF) of the Lisfranc complex with a suture button and stabilization of the medial and intermediate cuneiform with a 4.0-mm screw. Eighty-four patients were available for a 3-year minimum follow-up. The mean return to full weightbearing was 11 days protected in a controlled ankle motion (CAM) boot. American Orthopedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scores improved from 30 and 8.4, respectfully, preoperatively to 90 and 1.3 postoperatively. The mean preoperative step-off between the second metatarsal base and intermediate cuneiform was found to be 3.15 mm. The immediate postreduction weightbearing radiograph measured 0.25 mm and 0.43 mm at the final follow-up evaluation, a difference that was found to be significant. There were no revision arthrodeses performed and no removal of the suture button during this time period. ORIF using an interosseous suture button appears to have an adequate medium-term patient satisfaction; however, there is evidence of minimal diastasis in some patients at 3 years postoperatively in ligamentous Lisfranc fracture dislocations.

Surgical Trends in the Treatment of Lisfranc Injuries Using the American Board of Orthopaedic Surgery (ABOS) Certification Examination Database.

Background: Lisfranc joint complex injury may be managed surgically by either an open reduction internal fixation (ORIF) or primary arthrodesis (PA). Published literature advocates PA for purely ligamentous injuries, but many surgeons in actuality refrain from performing PA. The purpose of the study is to assess surgeon practices and behavior in managing Lisfranc injuries due to the influence of peer reviewed literature with the help of the American Board of Orthopaedic Surgery (ABOS) database. Methods: Data were requested from the ABOS database of cases on Lisfranc joint injury requiring either an ORIF or PA from examination year 2004 to 2017 for both part II and maintenance of certification (MOC) examinees. Cases with ICD-9 code 838.03 only were considered as primarily ligamentous and all fracture codes classified under 825 with 838.03 were considered as fracture dislocation. The number of PA and ORIF were recorded for both types of examinees and specific type of Lisfranc joint injury (primarily ligamentous and fracture dislocation). Results: A total of 2010 cases of Lisfranc joint injuries managed surgically by 1230 board-eligible orthopaedic surgeons. Open fractures (93) and non-/malunion fractures were excluded. A total of 1016 primarily ligamentous and 474 fracture dislocation cases were performed by part II examinees. Overall, 288 primarily ligamentous and 139 fracture dislocation cases were performed by MOC examinees. A total of 27 PA were performed in the primarily ligamentous and 17 were performed on fracture dislocation cases. Conclusion: ORIF is commonly performed by newly trained and senior orthopaedic surgeons. There was no change in the number of PA performed on primarily ligamentous injuries in spite of the published literature.Levels of Evidence: Not applicable.

Effect comparison between open reduction internal fixation and primary arthrodesis for treatment of Lisfranc injuries combined with first tarsal joint dislocation

Objective To compare the effect and prognosis outcome of open reduction internal fixation and primary arthrodesis in treatment of Lisfranc injuries combined with the first tarsal joint dislocation. Methods A retrospective case control study was conducted on the clinical data with complete follow up data of 126 patients with Lisfranc injuries combined with the first tarsal joint dislocation in nine ankle surgery centers of China from January 2009 to June 2015. There were 76 males (60.3%) and 50 females (39.7%) with an average age of 45.5 years (range, 20-87 years). Among the 126 cases, simple dislocation occurred in 41 cases(32.5%), and fracture dislocation in 85 cases (67.5%). The duration from injury to surgery was 11.7 days (range, 4-26 days). According to surgery method, the patients were divided into open reduction internal fixation group (n=92) and primary arthrodesis group (n=34). The outcomes were evaluated by American Orthopedic Foot and Ankle Society(AOFAS) score, 36-items short form health survey (SF-36), and visual analogue score (VAS). Complications were also followed up. Results All patients were followed up for 18-80 months, with an average of 29.5 months. Primary union was seen in all the patients. At the last follow up, the mean AOFAS midfoot score was (79.4±6.7)points in open reduction and internal fixation group and (85.1±8.3)points in primary arthrodesis group(P 0.05). The body pain score of SF-36 was (76.1±4.6)points in open reduction and internal fixation group and (84.6±8.7)points in primary arthrodesis group (P<0.05). In open reduction and internal fixation group, there were five cases (5%) with internal fixator loosening or fracture, 16 cases (17%) with redislocation, 36 cases (39%) with obvious pain of the middle foot during walking, and eight cases (6%) with tarsal joint traumatic arthritis which was given phase II arthrodesis. In primary arthrodesis group, two patients (6%) reported pain due to internal fixation, and the pain was relieved after fixator removal. No re-dislocation, loosening of internal fixation, or traumatic arthritis were found (P<0.05). Conclusion For Lisfranc injuries combined with first tarsal joint dislocation, primary arthrodesis can stabilize the first tarsal joint and avoid complications or adverse consequences such as redislocation, pain, internal fixation failure, or reoperation. Key words: Foot injuries; Fracture fixation, internal; Arthrodesis

Risk factors associated with re-operation following surgical treatment of lisfranc injuries

Risk factors associated with re-operation following surgical treatment of lisfranc injuries

Radiographic Outcomes of Lisfranc Injuries Treated with a Suture Button Device

Category: Trauma Introduction/Purpose: Disagreement exists as to the optimal treatment of Lisfranc injuries of the midfoot. Some authors suggest that primary arthrodesis should be the treatment of choice, whereas others are proponents of open reduction and internal fixation (ORIF). There has been increased interest in using a suture button device in lieu of traditional screw fixation, which in general must be removed. Biomechanical studies comparing screw fixation with suture button devices have had conflicting results. The aim of this study was evaluate patients with Lisfranc injuries treated with a suture button radiographically over time. Methods: 43 patients with a Lisfranc injury treated surgically with a suture button device (Tightrope, Arthrex, Naples, FL) by two fellowship-trained orthopaedic foot and ankle surgeons were identified via a database query for the CPT code 28615 (open treatment of tarsometatarsal joint dislocation). The distances between the first and second metatarsal (M1-M2) and between the medial cuneiform and the second metatarsal (C1-M2) were measured on anterior-posterior (AP) radiographs using standardized, readily-identifiable landmarks. All measurements were performed independently by two musculoskeletal radiologists and were averaged. Accuracy of reduction was assessed by comparing measurements on weightbearing AP radiographs of the uninjured foot with the operatively-treated foot at 6 weeks postoperatively, also weightbearing. Maintenance of reduction over time was assessed by comparing measurements at 6 weeks postoperatively with measurements taken at the time of last follow-up. Measurements were also compared between the injured foot preoperatively and at time of last follow-up. T-tests using SPSS software were performed for statistical analysis in comparing the means of the different measurements. Results: Average radiographic follow-up was 35.8 weeks (6.1-178.9). Accuracy of reduction was less than 1 mm for both the M1- M2 and C1-M2 measurements when comparing the uninjured foot with the surgically-treated foot at 6 weeks postoperatively; this difference was significant in the C1-M2 measurement (difference = 0.77 mm, p=0.032), but not in the M1-M2 measurement (difference = 0.44 mm, p=0.190). There was no significant difference in measurements between 6 weeks postoperatively and at final follow-up (difference in M1-M2=0.22 mm, p=0.435; difference in C1-M2=0.27 mm, p=0.352). There was significant improvement in the measured distances of the injured foot preoperatively to that measured at final follow-up in the C1-M2 measurements (difference in C1-M2=-0.82mm, p=0.021), while the difference in the M1-M2 measurements approached significance (difference in M1-M2= -0.56 mm, p=0.067). Conclusion: To our knowledge, this is the first and largest series assessing radiographic outcomes of Lisfranc injuries in patients treated surgically with a suture button device. After open reduction of Lisfranc injuries, the suture-button device used in this study appears to adequately maintain this reduction over time while patients are weightbearing and back to full activity. We therefore conclude that based on our results, the suture button appears to present an effective alternative to traditional screw fixation for treatment of Lisfranc injuries.

Dorsal plates for the treatment of Lisfranc injury: Short term results

Dorsal plates for the treatment of Lisfranc injury: Short term results

Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury

PurposeTo investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. MethodsTen cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years (mean 32 years). Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents (3 cases), fall from height (5 cases) and hit by heavy object (2 cases). All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6–10 days (average 6.6 days). Postoperatively, the foot function was assessed using Visual Analogue Scales (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) Scales. Healing time and complications were observed. ResultsAll patients were followed up for 18–24 months (average 20 months). Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score (7.89 ± 0.34) and score at postoperative 8 weeks (0.67 ± 0.13). According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. ConclusionAnatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients' quality of life.

Outcome comparison of Lisfranc injuries treated through dorsal plate fixation versus screw fixation.

OBJECTIVE: The objective of this prospective study was to test whether the treatment of Lisfranc injuries with open reduction and dorsal plate fixation would have the same or better functional outcomes as treatment with standard trans-articular screw fixation. METHODS: Sixty patients with primarily isolated Lisfranc joint injury were treated by open reduction and dorsal plate fixation or standard screw fixation. The patients were followed on average for 31 months. Evaluation was performed with patients' chief complaint, clinical examination, radiography, and AOFAS Midfoot Scale. RESULTS: Thirty two patients were treated with open reduction and dorsal plate fixation, and twenty eight patients were treated with open reduction and screw fixation. After two years follow-up, the mean AOFAS Midfoot score was 83.1 points in the dorsal plate fixation group and 78.5 points in the screw fixation group (p<0.01). Of the dorsal plate fixation group, radiographic analysis revealed anatomic reduction in twenty-nine patients (90.6%, 29/32) and nonanatomic reduction in three patients. Of the screw fixation group, radiographic analysis revealed anatomic reduction in twenty-three patients and nonanatomic reduction in five patients (82.1%, 23/28). CONCLUSIONS: Open reduction and dorsal plate fixation for a dislocated Lisfranc injury do have better short and median term outcome and a lower reoperation rate than standard screw ORIF. In our experience, we recommend using dorsal plate in ORIF on dislocated Lisfranc injuries. Level of Evidence II, Prospective Comparative Study.

Joint Preserving Techniques for Lisfranc Injury

The goal in the treatment of Lisfranc injuries is to obtain and maintain anatomic reduction of the tarsometatarsal joints so that the ligaments, bones, and articular surfaces can heal in a manner that will minimize the development of symptomatic posttraumatic arthritis, maintain the normal longitudinal arch of the foot, and preserve the normal physiologic function of the midfoot. Although the extent of damage caused by the initial injury cannot be controlled, the surgeon can limit disability by optimizing the final maintained reduction; minimizing further iatrogenic bone, articular cartilage, nerve, and soft-tissue damage during surgical treatment; and providing appropriate postoperative care. This can best be obtained by appropriate surgical indications and careful surgical techniques including fixation methods such as joint bridging plates and screws placed in the anatomic locations of the Lisfranc and intercuneiform ligaments that are strong enough to maintain reduction until bone and ligament healing occur but avoid the additional articular cartilage damage caused by transarticular screws. Orthobiologics may play a role in aiding ligament and bone healing in these injuries.

The Treatment of Lisfranc Injuries: Review of Current Literature.

Tarsometatarsal or Lisfranc fracture dislocations (LFD) are rare, easily overlooked, and lead to long-term disability. Recognition of such injuries is important so that adequate treatment can be provided. As many as 20% of LFD are either misdiagnosed or overlooked, and these can be a permanent source of pain in polytraumatic patients after the major fractures have healed. It is important to distinguish pure Lisfranc joint dislocations (LD) from LFD and Chopart-Lisfranc dislocations (CLFD). Here, we discuss the protocols for treating these different types of injury.

Treatment of Lisfranc Injuries in the Athlete

! ABSTRACT Lisfranc injuries in the athlete can be challenging problems for the treating physician. The injury pattern can range from the very subtle ligament tear with diastasis to complicated fracture‐dislocations. Proper treatment requires careful examination and use of imaging studies. Patients exhibiting fractures with displacement or subluxation generally require operative fixation because restoration of anatomic position is a key to a successful outcome. The main long-term complication is posttraumatic arthritis of the mid foot. Although the treatments vary from case to case, the goal when managing Lisfranc injuries in athletes remains universal: a return to sports at or near the preinjury level.