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Yi Y, Chaudhari S. Various Flexible Fixation Techniques Using Suture Button for Ligamentous Lisfranc Injuries: A Review of Surgical Options. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1134. [PMID: 37374337 DOI: 10.3390/medicina59061134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Contrary to Lisfranc joint fracture-dislocation, ligamentous Lisfranc injury can lead to additional instability and arthritis and is difficult to diagnose. Appropriate procedure selection is necessary for a better prognosis. Several surgical methods have recently been introduced. Here, we present three distinct surgical techniques for treating ligamentous Lisfranc employing flexible fixation. First is the "Single Tightrope procedure", which involves reduction and fixation between the second metatarsal base and the medial cuneiform via making a bone tunnel and inserting Tightrope. Second is the "Dual Tightrope Technique", which is similar to the "Single Tightrope technique", with additional fixation of an intercuneiform joint using one MiniLok Quick Anchor Plus. Last but not least, the "internal brace approach" uses the SwiveLock anchor, particularly when intercueniform instability is seen. Each approach has its own advantages and disadvantages in terms of surgical complexity and stability. These flexible fixation methods, on the other hand, are more physiologic and have the potential to lessen the difficulties that have been linked to the use of conventional screws in the past.
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Affiliation(s)
- Young Yi
- Department of Orthopedic Surgery, Seoul Foot and Ankle Center, Inje University Seoul Paik Hospital, 85, 2-ga, Jeo-dong, Jung-gu, Seoul 04551, Republic of Korea
| | - Sagar Chaudhari
- Department of Orthopedic Surgery, K. B. Bhabha Hospital, Bandra, Mumbai 400050, Maharashtra, India
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2
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Carter TH, Heinz N, Duckworth AD, White TO, Amin AK. Management of Lisfranc Injuries: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202304000-00001. [PMID: 37014938 DOI: 10.2106/jbjs.rvw.22.00239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
» There is a spectrum of midtarsal injuries, ranging from mild midfoot sprains to complex Lisfranc fracture-dislocations. » Use of appropriate imaging can reduce patient morbidity, by reducing the number of missed diagnoses and, conversely, avoiding overtreatment. Weight-bearing radiographs are of great value when investigating the so-called subtle Lisfranc injury. » Regardless of the operative strategy, anatomical reduction and stable fixation is a prerequisite for a satisfactory outcome in the management of displaced injuries. » Fixation device removal is less frequently reported after primary arthrodesis compared with open reduction and internal fixation based on 6 published meta-analyses. However, the indications for further surgery are often unclear, and the evidence of the included studies is of typically low quality. Further high-quality prospective randomized trials with robust cost-effectiveness analyses are required in this area. » We have proposed an investigation and treatment algorithm based on the current literature and clinical experience of our trauma center.
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Affiliation(s)
- Thomas H Carter
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nicholas Heinz
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Timothy O White
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Anish K Amin
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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3
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DeLuca MK, Boucher LC. Morphology of the Lisfranc Joint Complex. J Foot Ankle Surg 2023; 62:261-266. [PMID: 35973899 DOI: 10.1053/j.jfas.2022.07.004] [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: 04/07/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 02/03/2023]
Abstract
Lisfranc injuries are complicated injuries of the tarsometatarsal joint with high rates of sequelae. Both anatomy and injury of the Lisfranc joint are variably documented. Descriptions of these injuries and their associated structures vary greatly. The most injured structures are those of the Lisfranc joint complex, which involves the medial cuneiform, second and third metatarsals, and the dorsal, interosseous, and plantar Lisfranc ligaments. This study sought to examine morphology of the Lisfranc joint in cadavers. Twenty-two embalmed cadaveric feet were dissected (13 male, 9 female, 80.3 years ± 14.03) to isolate the bones and ligaments of the Lisfranc joint complex. The dorsal, interosseous, and plantar Lisfranc ligaments were present in each specimen. Each ligament was measured and morphology noted. The dissected dorsal Lisfranc ligament had consistent morphology (mean = 10.8 mm ± 1.79). The interosseous Lisfranc ligament had a consistent path, but 11/17 of specimens possessed a connection to the plantar Lisfranc ligament. The plantar Lisfranc ligament demonstrated wide variability with a Y-variant (n = 3) and a fan-shaped variant (n = 14). Ligament thickness was greatest in the interosseous Lisfranc ligament (mean = 13.74 ± 3.08) and least in the dorsal Lisfranc ligament (mean = 1.36 ± 0.42). While the objective of defining joint and ligament morphology was achieved, further questions were raised. Variations of the interosseous and plantar Lisfranc ligament may play a role in susceptibility to joint injury, and arthritic changes to the joints examined raise questions regarding the prevalence of arthritis in the uninjured Lisfranc joint.
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Affiliation(s)
- Meridith K DeLuca
- Division of Anatomy, The Ohio State University College of Medicine, Columbus, OH.
| | - Laura C Boucher
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH
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4
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Martin MP, Patel AH, Cole MW, Gadinsky NE, Collins L, Sherman WF. A Rare Case of a Lisfranc Ligament Transection. Orthop Rev (Pavia) 2023; 15:56664. [PMID: 36776274 PMCID: PMC9907328 DOI: 10.52965/001c.56664] [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] [Indexed: 01/29/2023] Open
Abstract
Ligamentous Lisfranc injuries, which mimic a surgical transection are rare. Left untreated or missed, these injuries may result in severe complications including long-term disability. The present case describes a unique mechanism of injury via a sharp object puncture through the plantar surface of the midfoot. It highlights the utility of planning staged procedures to remove a large foreign body object, reports notable intraoperative techniques, and provides a decision management guide for treating this type of injury. Extensive surgical planning may be required when encountering similar cases and knowledge of this may be useful to providers.
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Affiliation(s)
| | | | | | | | - Lacee Collins
- Orthopaedic SurgeryTulane University School of Medicine
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5
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Lalwani R, Kotgirwar S, Athavale SA. Support system of Lisfranc joint complex: An anatomical investigation with an evolutionary perspective. Foot Ankle Surg 2022; 28:1089-1093. [PMID: 35339373 DOI: 10.1016/j.fas.2022.03.004] [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: 01/14/2022] [Revised: 02/18/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The anatomical arrangement of the Lisfranc joint between the midfoot and forefoot is complex and not just critical for bipedal gait but also for prevention, management, and rehabilitation of injuries in this region. MATERIAL AND METHODS In forty adult cadaveric lower limbs, the Lisfranc mortise, the ligaments and supports were observed and noted. RESULTS The structural arrangement that accords stability to the joint has osseous, ligamentous, and tendinous components. A bony mortise, which is deep medially, disrupts the linearity of the joint line. An extensive Lisfranc ligament with confluent interosseous and plantar parts was observed. Tibialis posterior, peroneus Longus and Lisfranc ligament exhibit a unique anatomical arrangement that supports the joint inferiorly. CONCLUSION The study documents a unique lattice of tendons and ligament offering dynamic support to the joint. Demands of assumption of erect posture and bipedal walking in humans like adduction of the first ray of the foot, maintenance of longitudinal and transverse arches of the foot and ability stiffen midfoot for efficient forefoot take-off are well reflected in the joint structure and supports.
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Affiliation(s)
- Rekha Lalwani
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, M.P., India.
| | - Sheetal Kotgirwar
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, M.P., India
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Cho SH, Chung CY, Park MS, Sung KH, Choi JH, Koo S, Lee KM. Intrasubject Radiographic Progression of Hallux Valgus Deformity in Patients With and Without Metatarsus Adductus: Bilateral Asymmetric Hallux Valgus Deformity. J Foot Ankle Surg 2022; 61:17-22. [PMID: 34229914 DOI: 10.1053/j.jfas.2020.05.025] [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: 02/24/2019] [Revised: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 02/03/2023]
Abstract
This study was to analyze intrasubject radiographic progression of the hallux valgus deformity by comparing the mildly and severely affected sides in patients with bilateral asymmetric hallux valgus in the whole group as well as the metatarsus adductus and the nonmetatarsus adductus subgroups. A total of 186 patients with bilateral asymmetrical hallux valgus deformity with a difference of 5° or greater in the hallux valgus angle were included, and 11 radiographic measurements were analyzed. The radiographic differences between the mildly and severely affected sides were compared. Correlation between the changes in the hallux valgus angle and those in other measurements was analyzed, and multiple regression analyses were performed. The anteroposterior talo-second metatarsal angle showed no significant difference between the mildly and severely affected sides. Changes in the intermetatarsal angle and sesamoid rotation angle were significantly associated with the progression of hallux valgus angle in the whole group as well as the nonmetatarsus adductus subgroup. Change in the intermetatarsal angle (p = .006) was the significant factor associated with the progression of hallux valgus angle in the metatarsus adductus subgroup. The anteroposterior talo-second metatarsal angle might be useful in evaluating the overall foot shape in the hallux valgus deformity. Progression of the hallux valgus deformity might be pathophysiologically different between those with and without metatarsus adductus.
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Affiliation(s)
- Sung Hee Cho
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul national University Bundang Hospital, Seongnam, Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul national University Bundang Hospital, Seongnam, Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul national University Bundang Hospital, Seongnam, Korea
| | - Ji Hye Choi
- Department of Orthopaedic Surgery, Seoul national University Bundang Hospital, Seongnam, Korea
| | - Seungbum Koo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejon, Korea
| | - Kyoung Min Lee
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejon, Korea.
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7
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Won HJ, Oh CS. Classification of the interosseous tarsometatarsal ligaments of the foot. Foot Ankle Surg 2022; 28:72-78. [PMID: 33574006 DOI: 10.1016/j.fas.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to clarify the anatomical features of the interosseous tarsometatarsal ligaments of foot and to classify their types based on the combinations of their ligamentous components. METHODS Fifty feet from 27 adult Korean cadavers were dissected. RESULTS The interosseous tarsometatarsal ligaments were observed in the first, second, and third cuneometatarsal joint spaces. The interosseous tarsometatarsal ligament of the first cuneometatarsal space consistently connected the medial cuneiform and the second metatarsal, and was accompanied by one or two accessory ligaments above (34%) and/or below (6%) the Lisfranc ligament. The interosseous tarsometatarsal ligaments of the second and third cuneometatarsal joint spaces comprised seven and five components, and were classified into five and three types depending on the number and combination of the components, respectively. CONCLUSIONS These results are expected to advance the current knowledge on the tarsometatarsal joint and provide helpful information for more accurate and successful diagnosis and treatment of lesions at this joint.
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Affiliation(s)
- Hyung-Jin Won
- Department of Anatomy, School of Medicine, Kangwon National University, Chuncheon, Kangwon-do 24341, Republic of Korea
| | - Chang-Seok Oh
- Department of Anatomy, Sungkyunkwan University School of Medicine, Jangan-gu, Suwon, Gyeonggi-do 440-746, Republic of Korea.
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Yongfei F, Chaoyu L, Wenqiang X, Xiulin M, Jian X, Wei W. Clinical outcomes of Tightrope system in the treatment of purely ligamentous Lisfranc injuries. BMC Surg 2021; 21:395. [PMID: 34743702 PMCID: PMC8573989 DOI: 10.1186/s12893-021-01394-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background Purely ligamentous Lisfranc injuries are mainly caused by low energy damage and often require surgical treatment. There are several operative techniques for rigid fixation to solve this problem clinically. This study evaluated the effect of using the Tightrope system to reconstruct the Lisfranc ligament for elastic fixation. Methods We retrospectively analyzed 11 cases with purely ligamentous Lisfranc injuries treated with the Tightrope system from 2016 to 2019, including 8 male and 3 female. X-ray was performed regularly after operation to measure the distance between the first and second metatarsal joint and the visual analogue scale (VAS) score was used to evaluate pain relief. American orthopedic foot & ankle society (AOFAS) and Maryland foot score were recorded at the last follow-up. Results The average follow-up time was 20.5 months (range, 17–24). There was statistically significant difference in the distance between the first and second metatarsal joint and VAS score at 3 months, 6 months, and the last follow-up when compared with preoperative values (P < 0.05).Mean of postoperative AOFAS mid-foot scale and Maryland foot score were 92.4 ± 4.3, 94.1 ± 3.5, respectively. The Tightrope system was not removed and the foot obtained better biomechanical stability. No complications occurred during the operation. Conclusion Tightrope system in the treatment of purely ligamentous Lisfranc injuries can stabilize the tarsometatarsal joint and achieve satisfactory effect.
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Affiliation(s)
- Fan Yongfei
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Liu Chaoyu
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Xu Wenqiang
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Ma Xiulin
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Xu Jian
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China
| | - Wang Wei
- Department of Orthopaedic Surgery, Anhui Spinal Deformity and Clinical Medical Research Center, Fuyang Hospital Affiliated to Anhui Medical University, Fuyang People's Hospital, Fuyang, 236000, Anhui, People's Republic of China.
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9
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Bhimani R, Sornsakrin P, Ashkani-Esfahani S, Lubberts B, Guss D, De Cesar Netto C, Waryasz GR, Kerkhoffs GMMJ, DiGiovanni CW. Using area and volume measurement via weightbearing CT to detect Lisfranc instability. J Orthop Res 2021; 39:2497-2505. [PMID: 33368556 DOI: 10.1002/jor.24970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/29/2020] [Accepted: 12/21/2020] [Indexed: 02/04/2023]
Abstract
Weightbearing CT (WBCT) allows evaluation of the Lisfranc joint under physiologic load. We compared the diagnostic sensitivities of one-dimensional (1D) distance, two-dimensional (2D) area, and three-dimensional (3D) volumetric measurement of the injured Lisfranc joint complex (tarsometatarsal, intertarsal, and intermetatarsal) on WBCT among patients with surgically-confirmed Lisfranc instability. The experimental group comprised of 14 patients having unilateral Lisfranc instability requiring operative fixation who underwent preoperative bilateral foot and ankle WBCT. The control group included 36 patients without foot injury who underwent similar imaging. Measurements performed on WBCT images included: (1) Lisfranc joint (medial cuneiform-base of second metatarsal) area, (2) C1-C2 intercuneiform area, (3) C1-M2 distance, (4) C1-C2 distance, (5) M1-M2 distance, (6) first tarsometatarsal (TMT1) angular alignment, (7) second tarsometatarsal (TMT2) angular alignment, (8) TMT1 dorsal step off distance, and (9) TMT2 dorsal step-off distance. In addition, the volume of the Lisfranc joint in the coronal and axial plane were calculated. Among patients with unilateral Lisfranc instability, all WBCT measurements were increased on the injured side as compared to the contralateral uninjured side (p values: <.001-.008). Volumetric measurements in the coronal and axial plane had a higher sensitivity (92.3%; 91.6%, respectively) and specificity (97.7%; 96.5%, respectively) than 2D and 1D Lisfranc joint measurements, suggesting them to be the most accurate in diagnosing Lisfranc instability. The control group showed no difference in any of the measurements between the two sides. WBCT scan can effectively differentiate between stable and unstable Lisfranc injuries. Lisfranc joint volume measurements demonstrate high sensitivity and specificity, suggesting that this new assessment has high clinical implications for diagnosing subtle Lisfranc instability.
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Affiliation(s)
- Rohan Bhimani
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pongpanot Sornsakrin
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bart Lubberts
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel Guss
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Foot & Ankle Service, Newton-Wellesley Hospital, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cesar De Cesar Netto
- Department of Orthopaedics and Rehabilitation, Foot and Ankle Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Gregory R Waryasz
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Foot & Ankle Service, Newton-Wellesley Hospital, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences (AMS), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Christopher W DiGiovanni
- Foot & Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Foot & Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Foot & Ankle Service, Newton-Wellesley Hospital, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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10
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Chen J, Sagoo N, Panchbhavi VK. The Lisfranc Injury: A Literature Review of Anatomy, Etiology, Evaluation, and Management. Foot Ankle Spec 2021; 14:458-467. [PMID: 32819164 DOI: 10.1177/1938640020950133] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite being first described in the 1800s, the Lisfranc injury remains one of the most controversial topics in foot and ankle surgery. From the basic anatomy of the ligament complex to the optimal diagnostic and management methods, new research both sharpens and yet confounds our understanding of this unique injury. This article reviews the literature from established and classic papers to recent studies evaluating newer techniques. We discuss the unique bony and ligamentous anatomy, which confer strength to the Lisfranc complex, the typical mechanisms of injury, the most common classification systems, the clinical presentation, current imaging modalities, and conservative and surgical treatment options. We review studies comparing open reduction and internal fixation with primary arthrodesis of acute injuries, in addition to studies evaluating the various methods for obtaining fixation, including intra-articular screws, dorsal plates, and flexible fixation. It is clear from this review that despite the vast number of studies in the literature, much is still to be learned about the diagnosis and management of this challenging injury.Levels of Evidence: Level V: Expert opinion.
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Affiliation(s)
- Jie Chen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, NS, VKP)
| | - Navraj Sagoo
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, NS, VKP)
| | - Vinod Kumar Panchbhavi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, NS, VKP)
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11
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Abstract
Background. Injury to the Lisfranc interosseous ligament is currently managed with a screw. However, this can potentially further disrupt the ligament. The objective of this study was to observe the proximity of the screw or disruption it can cause at the ligament attachment sites. Methods. Twenty-three feet were studied. A 40-mm, 4.0, partially threaded, cannulated screw was inserted from the base of the second metatarsal into the medial cuneiform. The relationship of the ligament attachment sites to the screw hole were measured. Results. The screw hole contacted at least 1 of the ligament attachment sites in 20 of the 23 feet. The screw hole fully penetrated it in 7 feet, partially disrupted it in 4 feet, and had less than or equal to 1 mm of contact in 9 feet. There was no contact with either of the attachment sites in 3 feet, with an average distance of 1.5 mm separating them. Conclusion. Our results show the proximity of the ligament to the screw and the disruption that can result from its insertion. This is clinically relevant as some amount ligamentous disruption is likely to occur with insertion of the "Lisfranc screw," which may interfere with its healing process.Levels of Evidence: Level V: Expert opinion includes case reports and technique tips.
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Affiliation(s)
- Stephen Sierra
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
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12
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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.
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13
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Sripanich Y, Steadman J, Krähenbühl N, Rungprai C, Saltzman CL, Lenz AL, Barg A. Anatomy and biomechanics of the Lisfranc ligamentous complex: A systematic literature review. J Biomech 2021; 119:110287. [PMID: 33639336 DOI: 10.1016/j.jbiomech.2021.110287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/21/2020] [Accepted: 01/23/2021] [Indexed: 12/15/2022]
Abstract
Lisfranc injuries are challenging to treat and can have a detrimental effect on active individuals. Over the past decade researchers have investigated methods for the reconstruction of the Lisfranc ligamentous complex (LLC) to preserve its functional stability and mobility. To aid in this innovation, this study presents the current understanding of the anatomical and biomechanical characteristics of the LLC through a systematic review. Three medical databases (PubMed, Scopus, and Embase) were searched from inception through July 2019. Original studies investigating the anatomy and/or biomechanical properties of the LLC were considered for inclusion. Data recorded from each study included: number of cadavers, number of feet, gender, laterality, age, type of specimen, measurement methods, reported ligamentous bundles, ligament origins and insertions, geometric characteristics, and biomechanical properties of the LLC. The Quality Appraisal for Cadaveric Studies (QUACS) scale was used to assess the methodologic quality of included articles. Eight cadaveric studies investigating the LLC were included out of 1204 screened articles. Most articles described the LLC as three distinct structures: the dorsal- (DLL), interosseous- (ILL), and plantar- (PLL) Lisfranc Ligaments. The ILL had the largest thickness and insertional area of osseous attachment. Biomechanically, the ILL also had the highest stiffness and resistance to load prior to failure when loaded parallel to its fiber orientation. Current knowledge of the anatomical and biomechanical properties of the LLC are presented and highlight its significant role of stabilizing the tarsometatarsal articulation. Appreciating the biomechanical characteristics of the ILL may improve clinical insight in managing LLC injuries.
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Affiliation(s)
- Yantarat Sripanich
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - Jesse Steadman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Nicola Krähenbühl
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Chamnanni Rungprai
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Rajavithi Road, Tung Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Amy L Lenz
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA; Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany.
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14
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Thomas JL, Kopiec A, Mark K, Chandler LM. Radiographic Value of the Lisfranc Diastasis in a Standardized Population. Foot Ankle Spec 2020; 13:494-501. [PMID: 31791155 DOI: 10.1177/1938640019890738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. Injury to the Lisfranc's joint, in particular to the second metatarsal-medial cuneiform (second MMC) joint, can be difficult to evaluate, especially in subtle Lisfranc injuries. The purpose of this study was to determine the value of the Lisfranc joint width (diastasis) of the adult foot in a standardized population thereby establishing a potential reference range when investigating this area for potential injury. Methods. The 2nd MMC joint in 50 men and 50 women was evaluated. Individuals with a history of foot/ankle pain, previous foot/ankle operation or fracture, or a history of systemic disease were excluded from the study. Bilateral weightbearing digital anterior-posterior and lateral radiographs were taken using a standardized method. Results. The mean 2nd MMC diastasis in 200 feet was 5.6 mm (95% CI 5.39-5.81). In the female population, the mean 2nd MMC diastasis was 5.8 mm (95% CI 5.51-6.09) as compared with 5.6 mm (95% CI 5.31-5.89) in males. The mean distance between the fifth metatarsal base and first cuneiform in the entire study population was 16.3 mm (95% CI 15.57-17.03). Conclusion. This study helps define baseline measurements of the Lisfranc joint for the general population, which can provide a standard measurement against which suspected foot injuries can be compared.Level of Evidence: Level IV.
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Affiliation(s)
- James L Thomas
- Department of Orthopedics, Joan C. Edwards School of Medicine, Marshall University, Huntington, Wyoming
| | - Adam Kopiec
- Department of Orthopedics, Joan C. Edwards School of Medicine, Marshall University, Huntington, Wyoming
| | - Kunkel Mark
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, Alabama
| | - L Mae Chandler
- Department of Orthopedics and Podiatry, Foot and Ankle Concepts, Santa Barbara, California
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15
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Joannas G, Filippi J. How to Identify Unstable Lisfranc Injuries? Review of Diagnostic Strategies and Algorithm Proposal. Foot Ankle Clin 2020; 25:697-710. [PMID: 33543724 DOI: 10.1016/j.fcl.2020.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
"Misdiagnosed Lisfranc injuries can be as high as 50%, leading to chronic pain, functional impairment, and posttraumatic arthritis. Subtle or incomplete lesions are the most problematic group for an adequate diagnosis. Conventional non-weight-bearing radiographs can overlook up to 30% of unstable cases. Abduction stress radiographs and anteroposterior monopodial comparative weight-bearing radiographic views are very useful to identify instability. Computed tomography gives detailed information about fracture patterns and comminution. MRI can predict instability but it is expensive and not readily available in the acute setting."
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Affiliation(s)
- German Joannas
- Foot and Ankle Division "CEPP", Instituto Dupuytren, Av. Belgrano 3402, Ciudad Autónoma de Buenos Aires CP 1078, Argentina; Foot and Ankle Division, Orthopaedics Department, Centro Artroscópico Jorge Batista SA, Pueyrredón 2446 1er piso, Ciudad Autónoma de Buenos Aires (CABA) CP 1119, Argentina; Instituto Barrancas, Hipolito Yrigoyen 902, Quilmes, CP 1878, Buenos Aires, Argentina
| | - Jorge Filippi
- Department of Orthopedic Surgery, Foot and Ankle Unit, Clinica Las Condes, Estoril 450, Las Condes, Santiago 7591047, Chile; Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Ramon Carnicer 185, Providencia, Santiago 7501239, Chile.
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16
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Wang W, Fan Y, Liu C, Xu W, Ma X, Xu J, Yu H. [Short-term effectiveness of Endobutton plate in reconstruction of Lisfranc ligament]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1382-1386. [PMID: 33191694 DOI: 10.7507/1002-1892.202005034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To observe the short-term effectiveness of Endobutton plate in the reconstruction of Lisfranc ligament in tarsometatarsal joint injury. Methods Between March 2015 and July 2018, 18 patients with tarsometatarsal joint injuries were treated with Lisfranc ligament reconstruction by Endobutton plate. There were 12 males and 6 females with an average age of 32.5 years (range, 16-55 years). The causes of injury were traffic accident in 8 cases, falling from height in 3 cases, crushing by a heavy objective in 4 cases, and spraining in 3 cases. There were 10 cases of Myerson type A, 4 of type B1, 2 of type B2, 1 of type C1, and 1 of type C2. The interval between injury and operation ranged from 3 to 9 days (mean, 4.9 days). X-ray examination was performed regularly after operation to measure the distance between the first and the second metatarsal joints, and the visual analogue scale (VAS) score was used to evaluate the pain relief. At last follow-up, the reduction of tarsometatarsal joint was evaluated by measuring and comparing the height of the affected and healthy arches. The foot function was evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results The average follow-up time was 15.8 months (range, 10-28 months). All incisions healed by first intention. X-ray reexamination showed that there was no screw loosening or plate fracture. There were significant differences in the distance between the first and the second metatarsal joints and VAS score at 3 months after operation, before removal of the internal fixator, and at last follow-up when compared with preoperative values ( P<0.05). There was no significant difference between the time points after operation ( P>0.05). At last follow-up, there was no significant difference in the arch height between affected foot [(5.3±0.2) mm] and healthy foot [(5.4± 0.3) mm] ( t=1.798, P=0.810). The AOFAS score of foot function was 89.5±7.3 with excellent in 12 cases, good in 4 cases, and fair in 2 cases. The excellent and good rate was 88.9%. Conclusion The reconstruction of Lisfranc ligament with Endobutton plate can stabilize the tarsometatarsal joint and achieve satisfactory foot function at early stage.
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Affiliation(s)
- Wei Wang
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236000, P.R.China
| | - Yongfei Fan
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236000, P.R.China
| | - Chaoyu Liu
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236000, P.R.China
| | - Wenqiang Xu
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236000, P.R.China
| | - Xiulin Ma
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236000, P.R.China
| | - Jian Xu
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236000, P.R.China
| | - Haiyang Yu
- Department of Orthopaedic Surgery, Fuyang People's Hospital, Fuyang Clinical College of Anhui Medical University, Fuyang Anhui, 236000, P.R.China
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17
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Sripanich Y, Weinberg M, Krähenbühl N, Rungprai C, Saltzman CL, Barg A. Change in the First Cuneiform-Second Metatarsal Distance After Simulated Ligamentous Lisfranc Injury Evaluated by Weightbearing CT Scans. Foot Ankle Int 2020; 41:1432-1441. [PMID: 32819160 DOI: 10.1177/1071100720938331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to investigate the widening between the first cuneiform (C1) and second metatarsal (M2) in a Lisfranc ligamentous complex (LLC) joint injury model subjected to successive ligament dissections evaluated by weightbearing computed tomography (CT) scans. METHODS Twenty-four intact cadaveric feet served as the control (condition 1). Each component of the LLC (dorsal, interosseous, and plantar ligaments-conditions 2, 3, and 4, respectively) were then sequentially dissected. The specimens were equally randomized to 1 of 3 additional dissections (first or second tarsometatarsal [TMT] joint capsule or first-second intercuneiform ligament [ICL]-conditions 5a, 5b, and 5c, respectively). One additional ligament was then randomly transected (eg, condition 6ac-transection of the first TMT capsule and ICL). Finally, the remaining ligament was transected (condition 7). After each dissection, CT scans were acquired under nonweightbearing (NWB, 0 kg), partial-weightbearing (PWB, 40 kg), and full-weightbearing (FWB, 80 kg) conditions. The distance between the lateral border of C1 and the medial border of M2 was assessed to evaluate diastasis. Linear regressions with 95% CIs and converted q values were used to compare the measured data. RESULTS No significant differences were found within the control. In condition 4, an average axial plane widening relative to control of 1.6 mm (95% CI, 1.5-1.8) and 2.1 mm (95% CI, 1.9-2.2) was observed under PWB and FWB. A coronal plane widening of 1.5 mm (95% CI, 1.3-1.6) and 1.9 mm (95% CI, 1.7-2.1) under PWB and FWB, respectively, was measured. A 95% CI of at least a 2-mm widening during PWB was demonstrated in 5c, 6ac, 6bc, and 7. CONCLUSIONS Weightbearing computed tomography (WBCT) scans were used to detect ligamentous Lisfranc injuries in a cadaveric model. Relative axial widening greater than 1.5 mm under PWB conditions could indicate a complete LLC injury. Complete transection of the intercuneiform 1-2 ligament was required to detect a 2-mm widening in the nonweightbearing condition. CLINICAL RELEVANCE This study provides insight on the detection of various severities of LLC injuries using WBCT imaging.
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Affiliation(s)
- Yantarat Sripanich
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.,Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Maxwell Weinberg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Nicola Krähenbühl
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Chamnanni Rungprai
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | | | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.,Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Suzuki Y, Edama M, Kaneko F, Ikezu M, Matsuzawa K, Hirabayashi R, Kageyama I. Morphological characteristics of the Lisfranc ligament. J Foot Ankle Res 2020; 13:46. [PMID: 32677989 PMCID: PMC7364469 DOI: 10.1186/s13047-020-00412-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to clarify the morphological characteristics of the Lisfranc ligament and the cuneiform 1-metatarsal 2&3 plantar ligament (CMPL). METHODS Forty legs from 20 cadavers were examined. Classification proceeded according to the number of fiber bundles in the Lisfranc ligament and the CMPL. Morphological features measured were fiber bundle length, width, thickness, and angle. RESULTS In Type I-a, the Lisfranc ligament and the CMPL were a single fiber bundle; in Type I-b, the Lisfranc ligament was a single fiber bundle, and the CMPL was two fiber bundles; in Type II-a, the Lisfranc ligament was a two fiber bundle, and the CMPL was a single fiber bundle; in Type II-b, the Lisfranc ligament and the CMPL were two fiber bundles; in Type III-a, the Lisfranc ligament was three fiber bundles, and the CMPL was a single fiber bundle; in Type III-b, the Lisfranc ligament was three fiber bundles, and the CMPL was two fiber bundles; in Type IV, the Lisfranc ligament and the CMPL could not be separated. Type I-a was seen in 37.5%, Type I-b in 10%, Type II-a in 30%, Type II-b in 7.5%, Type III-a in 7.5%, Type III-b in 2.5%, and Type IV in 5%. The Lisfranc ligament was significantly larger than the CMPL in total fiber bundle width, total fiber bundle thickness, and total fiber bundle angle. CONCLUSION The Lisfranc ligament had up to 3 fiber bundles and the CMPL had one or two fiber bundles; classifications were four types and two subgroups.
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Affiliation(s)
- Y Suzuki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - M Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan. .,Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan.
| | - F Kaneko
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - M Ikezu
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - K Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - R Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - I Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
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19
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Lisfranc fleck sign: characteristics and clinical outcomes following fixation using a percutaneous position Lisfranc screw. Eur J Trauma Emerg Surg 2020; 48:471-479. [PMID: 32561962 DOI: 10.1007/s00068-020-01415-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/06/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Avulsion of the Lisfranc ligament, fleck sign, results in unstable Lisfranc injuries. This cross-sectional study was conducted to investigate the characteristics of Lisfranc injuries with fleck sign and the clinical and radiological outcomes following closed reduction and percutaneous screw fixation. METHODS All consecutive operatively managed Lisfranc injuries with fleck sign were reviewed from 2016 to 2018. The injury pattern and characteristics of Lisfranc fleck sign were reviewed based on the preoperative CT scan. Postoperative complications besides radiological and clinical outcomes were assessed using visual analog scale (VAS) pain, American orthopedic foot and ankle society (AOFAS) midfoot scale, and foot function index (FFI). RESULTS Thirty patients (20 males; mean age, 36.9 ± 17.0; range, 12-69 years) with mean follow-up 16.9 ± 7.4 (range, 6-31) months were enrolled. Among 12 cases with avulsed Lisfranc ligament from the second metatarsal base, only two cases had isolated second metatarsal base fracture in plantar medial part while others had concomitant avulsion fracture of plantar aspect of the adjacent third and/or fourth metatarsal base. Mean of postoperative VAS pain, AOFAS midfoot scale, and FFI were 1.03 ± 0.29, 91.43 ± 1.43, 24.43 ± 6.66, respectively. We had seven (23.3%) removal of screws, two (6.6%) broken screws, four (13.3%) pulled-out screws, and six (20%) lost reductions in the final follow-up with good clinical functions. CONCLUSION Closed reduction and percutaneous fixation of the Lisfranc injuries with fleck sign by a single position screw could be a good surgical option with reliable and predictable outcomes without needing to remove the hardware, routinely.
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20
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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.
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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
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21
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Min BC, Chung CY, Park MS, Choi Y, Koo S, Jang S, Lee KM. Dynamic First Tarsometatarsal Instability During Gait Evaluated by Pedobarographic Examination in Patients With Hallux Valgus. Foot Ankle Int 2019; 40:1104-1109. [PMID: 31215243 DOI: 10.1177/1071100719850802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to investigate the pedobarographic characteristics of tarsometatarsal instability and to identify factors associated with pedobarographic first tarsometatarsal instability in patients with hallux valgus. METHODS Fifty-seven patients (mean age, 59.7 years; standard deviation, 11.4 years; 6 men and 51 women) with a hallux valgus angle (HVA) greater than 15 degrees were included. All patients underwent a pedobarographic examination along with weightbearing anteroposterior (AP) and lateral foot radiography. Radiographic measurements were compared between the 2 groups with and without pedobarographic first tarsometatarsal instability. The association between the radiographic and pedobarographic parameters of the first tarsometatarsal instability was analyzed using the chi-square test. Binary logistic regression analysis was performed to identify significant factors affecting pedobarographic first tarsometatarsal instability. RESULTS The HVA (P < .001), intermetatarsal angle (P = .001), and AP talo-first metatarsal angle were significantly different between the pedobarographically stable and unstable tarsometatarsal groups. There was no significant association between radiographic and pedobarographic instability of the first tarsometatarsal joint (P = .924). The HVA was found to be the only significant factor affecting pedobarographic tarsometatarsal joint instability (P = .001). CONCLUSION The pedobarographic examination has possible clinical utility in evaluating first tarsometatarsal joint instability in patients with hallux valgus. Patients with a greater HVA should be assessed for the presence of first tarsometatarsal instability, and the necessity of the Lapidus procedure should be considered. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Byung Cho Min
- 1 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | - Chin Youb Chung
- 1 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | - Moon Seok Park
- 1 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | - Young Choi
- 2 Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Pusan, Korea
| | - Seungbum Koo
- 3 Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejon, Korea
| | - Seonpyo Jang
- 1 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | - Kyoung Min Lee
- 1 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
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Jastifer JR, Christianson ER, VanZweden DJ, Gustafson PA. Feasibility of Transosseous Nonarticular Fixation of Lisfranc Injuries. Foot Ankle Int 2019; 40:672-678. [PMID: 30803261 DOI: 10.1177/1071100719830947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal techniques for Lisfranc open reduction and internal fixation techniques remain debated. The purpose of the current study was to describe the joints involved in Lisfranc fixation and to determine if nonarticular transosseous internal fixation would be possible. METHODS Twenty cadaver Lisfranc joints were dissected and the articular cartilage was quantified by calibrated digital imaging software. Utilizing CT data, a computational model of the foot was developed and the mean joint surface was mapped and nonarticular screw paths between bones was determined. RESULTS For the medial-middle cuneiform (C1-C2) connection, 27.3% of the lateral face of C1 and 43.7% of the medial face of C2 was articular cartilage. Three variations of articular morphology were observed on C1 and 2 on C2. From the 3D models, it was determined that a joint-sparing, transosseous screw trajectory was possible between C1 and the second metatarsal and between C1 and C2. These screw paths were large enough to accommodate clinically useful screw diameters (>5 mm). The screw trajectories were roughly perpendicular to the long axis of the foot and take a plantar-medial to dorsal-lateral orientation. CONCLUSION The articular surface of the Lisfranc joint was quantified for the first time and may be smaller than some surgeons realize. This study demonstrated the orientation required to minimize articular damage. CLINICAL RELEVANCE The clinical significance of the current study was that a nonarticular screw trajectory was possible, and this information may help guide the placement of these screws.
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Affiliation(s)
- James R Jastifer
- 1 Borgess Orthopedics, Kalamazoo, MI, USA.,2 WMU Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Claaßen L, Venjakob E, Yao D, Lerch M, Plaass C, Colsman CS, Ettinger S. The computed tomographybased anatomy of the ossa cuneiformia. Orthop Rev (Pavia) 2019; 11:7876. [PMID: 31210911 PMCID: PMC6551459 DOI: 10.4081/or.2019.7876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/22/2019] [Indexed: 11/04/2022] Open
Abstract
There is a lack of basic anatomic information regarding the ossa cuneiformia. The aim of the present descriptive study was the detailed evaluation of the anatomy of the ossa cuneiformia. We analyzed 100 computer tomography scans of feet without deformities or previous trauma. The length, height and width of each cuneiforme and their articular surfaces were assessed. We itemized the data to gender differences and to foot length. The medial cuneiforme os had a length of 24.0 mm ± 2.4 (mean ± standard deviation), a width of 17.3 mm ± 2.8 and a height of 28.0 mm ± 3.4. The respective values for the intermediate cuneiforme were 18.2 mm ± 2.1, 15.8 mm ± 2.1 and 22.5 ± 2.2 and for the lateral cuneiforme 26.4 mm ± 2.7, 17.2 mm ± 2.9 and 22.8 mm ± 2.9. We found statistical relevant differences regarding gender and foot length subgroups whereas not for all parameters. The present study illustrates basic anatomic data regarding the ossa cuneiformia. This information might be helpful for implant design and placement during midfoot surgery.
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Affiliation(s)
- Leif Claaßen
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Elina Venjakob
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Daiwei Yao
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Matthias Lerch
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Christian Plaass
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Christina Stukenborg- Colsman
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
| | - Sarah Ettinger
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Hannover Medical School, Hannover, Germany
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24
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Fernandez I, Weiss WM, Panchbhavi VK. Evaluation of the Area of the Lisfranc Ligament Damaged by Screw Fixation. Foot Ankle Spec 2019; 12:49-53. [PMID: 29575922 DOI: 10.1177/1938640018766605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A cannulated screw is currently the standard fixation method to reduce and stabilize diastasis at the lisfranc joint following injury. Currently, there is no literature examining the area of the lisfranc ligament damaged by screw placement. The objective of this investigation is to define the area of the ligament damaged by fixation with a 3.5-mm cannulated screw. MATERIALS AND METHODS Twelve cadaveric feet were dissected to identify the Lisfranc ligament metatarsal insertion site and origin on the medial cuneiform. A 3.5-mm cannulated screw was then passed over the course of the ligament and removed. The Lisfranc joint was then dissected to measure the dimensions of the ligament and damage from screw passage at the origin and insertion using imaging software. RESULTS Mean injury area on the metatarsal was 3.49 mm2 and the area of injury for the cuneiform was 3.33 mm2. The mean percent of the area damaged was calculated to be 1.75% and 2.43% at the cuneiform and metatarsal, respectively. CONCLUSION A proportionally small area of the Lisfranc ligament is disrupted following screw fixation, but the implications of this on ligament healing and outcomes remain to be elucidated. LEVELS OF EVIDENCE Level V: Cadaveric study.
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Affiliation(s)
- Isaac Fernandez
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech Health Sciences Center, El Paso, Texas (IF, WMW).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (VKP)
| | - William M Weiss
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech Health Sciences Center, El Paso, Texas (IF, WMW).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (VKP)
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech Health Sciences Center, El Paso, Texas (IF, WMW).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (VKP)
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De Los Santos-Real R, Canillas F, Varas-Navas J, Morales-Muñoz P, Barrio-Sanz P, Medina-Santos M. Lisfranc Joint Ligament Complex Reconstruction: A Promising Solution for Missed, Delayed, or Chronic Lisfranc Injury Without Arthritis. J Foot Ankle Surg 2018; 56:1350-1356. [PMID: 28843550 DOI: 10.1053/j.jfas.2017.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Indexed: 02/03/2023]
Abstract
The current classifications of "Lisfranc injury" can be purely ligamentous (low-grade midfoot sprains) or involve the osseous and articular structures (high-grade Lisfranc fracture displacements). The first type is often difficult to detect. If these patients are not properly treated, long-term disability can result. The rate of missed or delayed diagnoses has ranged from 13% to 24%, primarily owing to the subtlety of the radiographic findings. This is relatively more common in cases of subtle ligamentous injury (19%). The aim of the present report was to provide a new technique for missed or delayed Lisfranc injury without degenerative local signs. The Lisfranc ligament complex reconstruction is performed with a gracilis tendon graft and is protected by temporary screw fixation. We performed this technique in 3 patients. All 3 patients obtained good results, have been able to resume their previous activities, and have stated they would undergo this type of procedure again. The minimum follow-up length was 2 years.
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Affiliation(s)
- Raúl De Los Santos-Real
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Central Cruz Roja, Madrid, Spain; Associate Professor, Department of Orthopaedics, Universidad Alfonso X El Sabio, Madrid, Spain.
| | - Fernando Canillas
- Associate Professor, Department of Orthopaedics, Universidad Alfonso X El Sabio, Madrid, Spain; Head Physician and Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Central Cruz Roja, Madrid, Spain
| | - Jesús Varas-Navas
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitario Infanta Sofıa, Madrid, Spain; Associate Professor, Department of Orthopaedics, Universidad Europea de Madrid, Madrid, Spain
| | - Patricia Morales-Muñoz
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitario Infanta Sofıa, Madrid, Spain; Associate Professor, Department of Orthopaedics, Universidad Europea de Madrid, Madrid, Spain
| | - Patricia Barrio-Sanz
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Universitario Infanta Sofıa, Madrid, Spain; Associate Professor, Department of Orthopaedics, Universidad Europea de Madrid, Madrid, Spain
| | - Mónica Medina-Santos
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Hospital Central Cruz Roja, Madrid, Spain; Associate Professor, Department of Orthopaedics, Universidad Alfonso X El Sabio, Madrid, Spain
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Sivakumar BS, An VVG, Oitment C, Myerson M. Subtle Lisfranc Injuries: A Topical Review and Modification of the Classification System. Orthopedics 2018; 41:e168-e175. [PMID: 29451936 DOI: 10.3928/01477447-20180213-07] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/13/2017] [Indexed: 02/03/2023]
Abstract
Lisfranc injuries are relatively uncommon. No specific incidence of subtle injuries has been reported; however, almost one-third are missed on initial review. These missed injuries are a common cause of litigation. Although seen in high-energy injuries with direct application of forces, they are also associated with lower-energy indirect mechanisms, often on the athletic field. This article provides a topical review of subtle Lisfranc disruptions, focusing on contemporary perspectives, and describes a modification to the most prevalent classification system. [Orthopedics. 2018; 41(2):e168-e175.].
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Abstract
Joint disruptions to the tarsometatarsal (TMT) joint complex, also known as the Lisfranc joint, represent a broad spectrum of pathology from subtle athletic sprains to severe crush injuries. Although injuries to the TMT joint complex are uncommon, when missed, they may lead to pain and dysfunction secondary to posttraumatic arthritis and arch collapse. An understanding of the appropriate anatomy, mechanism, physical examination, and imaging techniques is necessary to diagnose and treat injuries of the TMT joints. Nonsurgical management is indicated in select patients who maintain reduction of the TMT joints under physiologic stress. Successful surgical management of these injuries is predicated on anatomic reduction and stable fixation. Open reduction and internal fixation remains the standard treatment, although primary arthrodesis has emerged as a viable option for certain types of TMT joint injuries.
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Abstract
To be able to perform percutaneous fixation of Lisfranc injuries, this article emphasizes that an anatomic reduction must be mandatory. When uncertainty remains as to whether closed reduction is anatomic, formal open reduction is recommended because accuracy of reduction is correlated with long-term outcome. Closed injuries with minimal displacement, bony avulsions, and skeletally immature individuals seem the most appropriate indications for percutaneous fixation. Not all injuries are ideal for this method of treatment, and this is an area that needs to be more clearly defined in the future.
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Affiliation(s)
- Rupesh A Puna
- Division of Orthopaedic Surgery, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
| | - Matthew P W Tomlinson
- Counties-Manukau Health Orthopaedics, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland 2104, New Zealand
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