1
|
Ahluwalia R, Yip G, Richter M, Maffulli N. Surgical controversies and current concepts in Lisfranc injuries. Br Med Bull 2022; 144:57-75. [PMID: 36151742 DOI: 10.1093/bmb/ldac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Lisfranc injuries, not as rare as previously reported, range from ligamentous to complex fracture-dislocations. Anatomical studies have identified a complex of discrete structures, and defined the anatomical characteristics of the Lisfranc joint. SOURCES OF DATA A narrative evidence-based review encompassed and analyzed published systematic reviews. Outcomes included clinical and surgical decision-making, including clinical-presentation, diagnosis, pathological-assessment, surgical-management techniques and indications, post-surgical care and comparative outcomes. AREAS OF AGREEMENT Better understanding of the Lisfranc complex anatomy aids surgical treatment and tactics. Prognosis is related to injury severity, estimated by the number of foot columns affected. Surgical outcome is determined by anatomical reduction for most fixation and fusion techniques. Appropriate treatment allows return to sport, improving outcome scores. AREAS OF CONTROVERSY Identification of Lisfranc injuries may be improved by imaging modalities such as weight-bearing computer tomography. Recent evidence supports dorsal plate fixation as a result of better quality of reduction. In complex injuries, the use of combined techniques such as trans-articular screw and plate fixation has been associated with poorer outcomes, and fusion may instead offer greater benefits. GROWING POINTS Open reduction is mandatory if closed reduction fails, highlighting the importance of understanding surgical anatomy. If anatomical reduction is achieved, acute arthrodesis is a safe alternative to open reduction internal fixation in selected patients, as demonstrated by comparable outcomes in subgroup analysis. AREAS FOR DEVELOPING RESEARCH The current controversies in surgical treatment remain around techniques and outcomes, as randomized controlled trials are infrequent.
Collapse
Affiliation(s)
- Raju Ahluwalia
- Department of Orthopaedics, King's College Hospital, King's College Hospital NHS Foundation Trust, Bessemer Road, London, SE5 9RS, UK
| | - Grace Yip
- Department of Orthopaedics, King's College Hospital, King's College Hospital NHS Foundation Trust, Bessemer Road, London, SE5 9RS, UK
| | - Martinus Richter
- Department for Foot and Ankle Surgery Nuremberg and Rummelsberg, Hospital Rummelsberg, Rummelsberg 71, Schwarzenbruck 90592, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Salerno, Italy.,Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK
| |
Collapse
|
2
|
Reliability of measurements assessing the Lisfranc joint using weightbearing computed tomography imaging. Arch Orthop Trauma Surg 2021; 141:775-781. [PMID: 32415387 DOI: 10.1007/s00402-020-03477-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Subtle Lisfranc joint injuries remain challenging to diagnose in clinical practice. Although of questionable accuracy, bilateral weightbearing radiographs are considered the current gold standard to assess these injuries. However, weightbearing computed tomography (WBCT), which provides clearer visualization of bony landmarks, can also be used for evaluation. This study aims to design a protocol that reliably measures the distance between the medial cuneiform (C1) and second metatarsal (M2) to assess the Lisfranc joint using WBCT imaging. METHODS Two unique methods of measuring the C1-M2 distance were designed that localize the center of the interosseous Lisfranc ligament (ILL, reference point). This reference point was located by (I) measuring a specific distance at the M2 base, or (II) approximating from nearby bony landmarks, on both axial (Ax) and coronal (Cor) WBCT images. Four parameters (I-Ax, I-Cor, II-Ax, and II-Cor) were evaluated for each of 96 specimens. Measurements were recorded by three independent observers and repeated for inter- and intra-observer agreement. RESULTS In total, 96 patient image series were included and assessed in our study with an average age of 46 (19-66, SD 16.1) and average BMI of 25.8 (17.8-30.5, SD 4.3). I-Ax showed excellent agreement for intra-observer evaluation (R = 0.802) and good agreement for inter-observer evaluation (R = 0.727). I-Cor demonstrated excellent inter- (R = 0.814) and intra-observer (R = 0.840) agreement. Good agreement was found for both II-Ax and II-Cor for both intra- (R = 0.730, R = 0.708) and inter-observer (R = 0.705, R = 0.645) evaluation. CONCLUSION Measuring the C1-M2 joint space with coronal WBCT imaging through a protocol that localizes the ILL is reproducible, simple, and can potentially be utilized clinically to evaluate the Lisfranc joint.
Collapse
|
3
|
Wu G, Gu S, Yu G, Yin F. Effect of different fusion types on kinematics of midfoot lateral column: a comparative biomechanical study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:665. [PMID: 31930066 DOI: 10.21037/atm.2019.10.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aimed to compare the biomechanical outcomes of the isolated 4th or 5th tarsometatarsal (TMT) joint arthrodesis with the whole lateral TMT joints arthrodesis. Methods Ten cadaveric lower legs underwent isolated 4th TMT joint arthrodesis, 5th TMT joint arthrodesis, and whole lateral TMT joints arthrodesis in sequence. Texson F-scan and K-scanTM joint sensor were used to test the medial and lateral plantar pressure and the pressure of calcaneocuboid joint. Results Compared with the intact foot, the lateral forefoot pressure increased significantly (P<0.05) after 4th TMT joint fusion. The medial forefoot pressure was significantly lower in the 5th TMT joint fusion than that in the intact foot (P<0.05) and the 4th TMT joint fusion (P<0.05), but higher than that in the whole lateral TMT joints fusion (P<0.05). On the contrary, the lateral forefoot pressure was significantly higher in the 5th TMT joint fusion than that in the intact foot and the 4th TMT joint fusion, but lower than that in the whole lateral TMT joints fusion (P<0.05). The medial forefoot pressure was the lowest (P<0.05) and lateral forefoot pressure was the highest (P<0.05) in the whole lateral TMT joints fusion. The calcaneocuboid joint pressure increased respectively with the intact foot being the lowest, followed by the isolated 4th TMT joint arthrodesis, the isolated 5th TMT joint arthrodesis, and the whole lateral TMT joints arthrodesis (P<0.05). Conclusions The isolated 4th or 5th TMT joint arthrodesis has less impact on the pressure of forefoot and adjacent joints than the whole lateral TMT joints arthrodesis. The isolated 4th TMT joint arthrodesis has the lowest influence on the pressure of forefoot and adjacent joints.
Collapse
Affiliation(s)
- Genbin Wu
- Department of Joint Surgery, Shanghai East Hospital, Tongji University, School of Medicine, Shanghai 200120, China.,Orthopaedic Hospital Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Shunan Gu
- Southern Medical University, Guangzhou 510000, China
| | - Guangrong Yu
- Department of Orthopedics, Tongji Hospital, Tongji University, School of Medicine, Shanghai 200120, China
| | - Feng Yin
- Department of Joint Surgery, Shanghai East Hospital, Tongji University, School of Medicine, Shanghai 200120, China
| |
Collapse
|
4
|
First and second floating metatarsals with ipsilateral open bimalleolar fracture and phalangeal fracture: a rare presentation of Lisfranc dislocation. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
5
|
Madi S, Vijayan S, Naik M, Rao S. Three floating metatarsals and a half-floating cuneiform. BMJ Case Rep 2015; 2015:bcr-2015-212360. [PMID: 26452415 DOI: 10.1136/bcr-2015-212360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Floating metatarsals are rare and complex injury patterns in the world of foot trauma. The injury is typically characterised by concomitant dislocations of the metatarsals from both articular ends ('bipolar dislocations'). Fascination arises from the fact that there have been only 15 cases reported in the English literature from 1964 to date. The first metatarsal has been more frequently reported than the lesser metatarsals. More than one floating metatarsal is also extremely uncommon. Inter-cuneiform diastasis is another rare entity seen in low velocity injuries and sports injuries; this condition is very difficult to diagnose clinically and radiologically. The occurrence of these two injury patterns in isolation is itself rare, making their combination even more unique.
Collapse
Affiliation(s)
- Sandesh Madi
- Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Sandeep Vijayan
- Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Monappa Naik
- Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Sharath Rao
- Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| |
Collapse
|
6
|
Yu X, Pang QJ, Yu GR. The injuries to the fourth and fifth tarsometatarsal joints: A review of the surgical management by internal fixation, arthrodesis and arthroplasty. Pak J Med Sci 2014; 29:687-92. [PMID: 24353608 PMCID: PMC3809252 DOI: 10.12669/pjms.292.2996] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 10/09/2012] [Accepted: 02/23/2013] [Indexed: 11/29/2022] Open
Abstract
The surgical management to the injuries of the fourth and fifth tarsometatarsal (TMT) joints is controversial. We briefly review the anatomical characteristics to the injuries, the diagnosis, as well as the individualized treatment of the injuries of the fourth and fifth TMT joints by open reduction and internal fixation, TMT arthrodesis and arthroplasty. We conclude that open reduction and internal fixation is the recommended option for acute injuries, while arthrodesis can be used in cases of malunion of the fourth and fifth TMT joints with gross pain or arthritic changes and obvious structural deformity. Arthroplasty is an effective salvage operation mainly used in high-demand patients with severe TMT arthritis. Finally, we propose a recommended treatment algorithm (based on the literature and our experience), taking into account the specific indications for internal fixation, TMT arthrodesis and arthroplasty to optimize the individualized treatment. Data sources/Study selection Data from survey reports, descriptive, cross-sectional and longitudinal studies published from 2002 to 2012 on the topic of the injuries to the fourth and fifth tarsometatarsal joint on human and radiography studies were included. Data Extraction The data was extracted from online resources of American Orthopaedic Foot & Ankle Society, American Academy of Orthopaedic Surgeons, US National Library of Medicine, The MEDLINE. Conclusion It is important to comprehend the specific anatomical characteristics and grasp the strict indications, advantages and disadvantages of the ORIF, TMT arthrodesis and arthroplasty to optimize the individualized treatment of the fourth and fifth TMT joints injuries in a maximum extent.
Collapse
Affiliation(s)
- Xiao Yu
- Xiao Yu, Department of Orthopedics Centre, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China
| | - Qing-Jiang Pang
- Qing-jiang Pang, Department of Orthopedics Centre, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China
| | - Guang-Rong Yu
- Guang-rong Yu, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai 20065, China
| |
Collapse
|
7
|
Eleftheriou KI, Rosenfeld PF. Lisfranc injury in the athlete: evidence supporting management from sprain to fracture dislocation. Foot Ankle Clin 2013; 18:219-36. [PMID: 23707175 DOI: 10.1016/j.fcl.2013.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Although Lisfranc injuries are uncommon, prompt and accurate diagnosis of such injuries in athletes is essential in preventing career-ending injury. Undisplaced injuries have an excellent result with nonoperative treatment. The presence of any displacement warrants open reduction and anatomic fixation; although current evidence mostly supports screw fixation, plate fixation may avoid joint intrusion. It is imperative to warn athletes with significantly displaced injuries that there is a risk of a poor outcome, although some recent evidence suggests that return to elite competitive sports is still likely after surgical intervention. Severe injuries may have better outcomes with limited arthrodesis.
Collapse
Affiliation(s)
- Kyriacos I Eleftheriou
- Department of Trauma and Orthopaedics, St Mary's Hospital, Praed Street, London W2 1NY, UK.
| | | |
Collapse
|
8
|
Eleftheriou KI, Rosenfeld PF, Calder JDF. Lisfranc injuries: an update. Knee Surg Sports Traumatol Arthrosc 2013; 21:1434-46. [PMID: 23563815 DOI: 10.1007/s00167-013-2491-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 03/26/2013] [Indexed: 12/19/2022]
Abstract
Lisfranc injuries are a spectrum of injuries to the tarsometatarsal joint complex of the midfoot. These range from subtle ligamentous sprains, often seen in athletes, to fracture dislocations seen in high-energy injuries. Accurate and early diagnosis is important to optimise treatment and minimise long-term disability, but unfortunately, this is a frequently missed injury. Undisplaced injuries have excellent outcomes with non-operative treatment. Displaced injuries have worse outcomes and require anatomical reduction and internal fixation for the best outcome. Although evidence to date supports the use of screw fixation, plate fixation may avoid further articular joint damage and may have benefits. Recent evidence supports the use of limited arthrodesis in more complex injuries.
Collapse
|
9
|
Lievers WB, Frimenko RE, Crandall JR, Kent RW, Park JS. Age, sex, causal and injury patterns in tarsometatarsal dislocations: a literature review of over 2000 cases. Foot (Edinb) 2012; 22:117-24. [PMID: 22560256 DOI: 10.1016/j.foot.2012.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 03/09/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND The causes and mechanisms of tarsometatarsal (TMT) dislocations are poorly characterized. Unfortunately, the rarity of these injuries makes it difficult and costly to gather the epidemiological data needed to better understand the populations at risk and the circumstances under which injury is most likely to occur. METHODOLOGY To address this issue, literature reports of TMT dislocations were identified and analyzed to generate statistical descriptions of the common causes of injury, the age and sex of those injured, and the pattern of injury. Over 2000 injuries were identified from 187 articles. RESULTS The analysis reveals that over 40% of injuries were related to traffic accidents. Based on the Hardcastle classification system, more than 60% of TMT dislocation were partial (type B) injuries. Over 55% of the injured were between 15 and 35 years of age, and males were injured more than twice as frequently. Conversely, the victims of falls tended to be older and represented a larger proportion of females. The age and sex of those injured by TMT dislocations vary by cause. CONCLUSION An improved understanding of the epidemiologic patterns will benefit research into the mitigation and prevention of these injuries.
Collapse
Affiliation(s)
- W Brent Lievers
- Center for Applied Biomechanics, University of Virginia, Charlottesville, VA 22901, USA.
| | | | | | | | | |
Collapse
|
10
|
Jeong JJ, Ji JH, Park SE, Kim YY. Locked floating first metatarsal: open reduction and no fixation - case report. Foot Ankle Int 2012; 33:70-3. [PMID: 22381239 DOI: 10.3113/fai.2012.0070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Level of Evidence: V, Expert Opinion
Collapse
|
11
|
Lasanianos NG, Kanakaris NK, Harris N, Giannoudis PV. Ipsilateral floating second metatarsal and ankle fracture dislocation: complications and outcome of a rare type of injury. Orthopedics 2010; 33. [PMID: 20506941 DOI: 10.3928/01477447-20100329-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Lisfranc fracture dislocations are complex lesions which, when combined with additional trauma of the ankle and foot region, create a difficult to treat injury pattern. This article presents a case of a patient with Lisfranc fracture dislocation combined with metatarsophalangeal dislocation of the second toe and ankle fracture-dislocation. The sequence of medical acts and complications included: reduction of dislocations, cast immobilization, compartment syndrome and fasciotomies, external fixator application, fasciotomies closure, and final internal fixations. The following examinations were performed: radiography, computed tomography (CT), and intracompartmental pressure measurement. Despite the compartment syndrome incidence, which was effectively managed, the patient regained an ankle- and foot-pain-free full range of motion. Although this is an isolated case of a rare injury, several recommendations can be made. Early CT scan should be used for injuries of the Lisfranc joints to fully assess the distorted anatomy of the midfoot and forefoot, which is essential for preoperative planning, medicolegal issues, and prognosis of the injury. The use of a spanning external fixator, especially in complex injuries as the one described, should be preferred to cast immobilization and should be performed as a priority surgical procedure early on in the patient's admission. The development of compartment syndrome should be monitored and intracompartmental pressures measured especially in unconscious patients. There should be a high degree of suspicion for early complications in complex fracture patterns, even if the initial clinical assessment is reassuring.
Collapse
Affiliation(s)
- N G Lasanianos
- Academic Unit of Trauma and Orthopedics, University of Leeds, Leeds General Infirmary, Leeds, United Kingdom
| | | | | | | |
Collapse
|
12
|
Abstract
Injuries to the Lisfranc ligament complex have traditionally been associated with high energy trauma such as motor vehicle collisions and industrial accidents. Recently, there has been a greater appreciation of mid-foot sprains that represent a spectrum of injury to the Lisfranc ligament complex. As a result, there has been an increased incidence of such injury resulting from low-energy trauma in activities ranging from recreational activity to elite athletic activity. This article discusses issues related to anatomy, clinical presentation, mechanism of injury, and diagnosis that are necessary to provide appropriate treatment for these injuries. There should be a high index of suspicion of this injury, and prompt diagnosis is important to allow athletes to return to sport with the best possible outcome.
Collapse
|
13
|
Mobarake MK, Saied A, Baron E. Concomitant dislocation of the tarsometatarsal and metatarsophalangeal joints of the second toe (floating second metatarsal): a case report. CASES JOURNAL 2009; 2:39. [PMID: 19134219 PMCID: PMC2628643 DOI: 10.1186/1757-1626-2-39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 01/10/2009] [Indexed: 11/25/2022]
Abstract
When examining patients with injuries of the tarsometatarsal joint, the physician must pay attention to the foot as a whole. An extremely rare foot injury has been described in which axial and compressive forces cause simultaneous dislocation of the tarsometatarsal joint and the metatarsophalangeal joint of the same or adjacent ray. The following is a report of one of these rare injuries. We will also discuss probable mechanism and diagnosis of this rare traumatic injury.
Collapse
|
14
|
Abstract
We report a 30-year-old patient suffering a plantar dislocation fracture after he dropped a heavy weight on his foot. The patient was treated immediately after diagnosis was secured by CT scan. Median approach and dermatofasciotomy of the foot were followed by anatomic reduction of the fractures and the Lisfranc dislocation and fixed by internal osteosynthesis. After 3 months the patient was able to ambulate pain free without walking aids. Plantar dislocation is a very rare direction of comminuted Lisfranc dislocation fractures. The outcome may be favorable with early reduction and stable internal fixation of the fractures. One always has to be aware of the major soft tissue trauma associated with complex Lisfranc dislocation fractures.
Collapse
Affiliation(s)
- B Kinner
- Abteilung für Unfallchirurgie, Klinikum der Universität, Franz-Josef-Strauss-Allee 11, 93042 Regensburg.
| | | | | | | |
Collapse
|
15
|
Shetty MS, Pinto D, Bhardwaj P. Isolated floating first metatarsal: report of an unusual injury. J Foot Ankle Surg 2007; 46:185-7. [PMID: 17466245 DOI: 10.1053/j.jfas.2006.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Indexed: 02/03/2023]
Abstract
The floating metatarsal is an extremely rare type of injury in which the first metatarsal is dislocated both proximally and distally. Associated injuries and especially metatarsal fracture appear to be rules rather than exceptions. An unreported type of foot injury consisting of isolated floating first metatarsal is described. The absence of any metatarsal fracture makes it exceptional. The importance of following an order of reduction of the joints to relieve tension on the plantar fascia has been highlighted. When examining a patient with metatarsophalangeal joint injury, one should always look for injury at the tarsometatarsal joint and vice versa, because various concomitant injuries are possible and misdiagnose can cause long-term secondary disability.
Collapse
|
16
|
Abstract
Complete dislocation of the first metatarsal represents an infrequent injury. The authors present the case of a 48-year-old man who sustained dislocation of the first metatarsal from both the metatarsophalangeal and tarsometatarsal joints in a motor vehicle accident. After open reduction, the first metatarsophalangeal joint was temporarily fixated with a Kirschner wire to maintain reduction, while the first metatarso-cuneiform joint was fixated with two cannulated screws. A discussion of the pertinent literature regarding this rare injury is also included.
Collapse
Affiliation(s)
- Rina Jain
- Sharp Grossmont Hospital, San Diego, CA, USA.
| | | |
Collapse
|
17
|
|