Lisfranc injuries: an update
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.
Available from: Matthew Welck
- "Since the middle and the medial columns are relatively rigid, they are stabilised with screw fixation or dorsal plating    . K-wire fixation is reserved for the more mobile lateral column   . If anatomical reduction can be achieved by closed reduction under fluoroscopy, then screws may be placed percutaneously . "
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ABSTRACT: Lisfranc injuries are commonly asked about in FRCS Orthopaedic trauma vivas. The term “Lisfranc injury” strictly refers to an injury where one or more of the metatarsals are displaced from the tarsus. The term is more commonly used to describe an injury to the midfoot centred on the 2nd tarsometarsal joint. The injury is named after Jacques Lisfranc de St. Martin (1790-1847), a French surgeon and gynaecologist who first described the injury in 1815. ‘Lisfranc injury’ encompasses a broad spectrum of injuries, which can be purely ligamentous or involve the osseous and articular structures. They are often difficult to diagnose and treat, but if not detected and appropriately managed they can cause long-term disability. This review outlines the anatomy, epidemiology, classification, investigation and current evidence on management of this injury.
Injury 12/2014; 46(4). DOI:10.1016/j.injury.2014.11.026 · 2.14 Impact Factor
Available from: Yan Wang
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ABSTRACT: Complications of surgeries in foot and ankle bring patients with severe sufferings. Sufficient understanding of the internal biomechanical information such as stress distribution, contact pressure, and deformation is critical to estimate the effectiveness of surgical treatments and avoid complications. Foot and ankle is an intricate and synergetic system, and localized intervention may alter the functions to the adjacent components. The aim of this study was to estimate biomechanical effects of the TMT joint fusion using comprehensive finite element (FE) analysis. A foot and ankle model consists of 28 bones, 72 ligaments, and plantar fascia with soft tissues embracing all the segments. Kinematic information and ground reaction force during gait were obtained from motion analysis. Three gait instants namely the first peak, second peak and mid-stance were simulated in a normal foot and a foot with TMT joint fusion. It was found that contact pressure on plantar foot increased by 0.42%, 19% and 37%, respectively after TMT fusion compared with normal foot walking. Navico-cuneiform and fifth meta-cuboid joints sustained 27% and 40% increase in contact pressure at second peak, implying potential risk of joint problems such as arthritis. Von Mises stress in the second metatarsal bone increased by 22% at midstance, making it susceptible to stress fracture. This study provides biomechanical information for understanding the possible consequences of TMT joint fusion.
Medical Engineering & Physics 04/2014; 36(11). DOI:10.1016/j.medengphy.2014.03.014 · 1.83 Impact Factor
Available from: PubMed Central
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: To summarize the functional outcome of tarsometatarsal joint fracture-dislocation managed according to Myerson classification.
: Total eighty cases of tarsometatarsal joint fracture-dislocation were treated from Mar 2004 to Feb 2012. According to the Myerson classification, there were 14 cases in type A, 12 cases in type B1, 28 cases in type B2, 11 cases in type C1 and 15 cases in type C2. All the cases were treated with open reduction and internal fixation and the incisions and implants were also selected according to the Myerson classification. X-ray was examined during the follow-up period and functional evaluation was carried out by American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score system. Analysis of variance was used to test the different types of Myerson classification.
: Sixty eight patients got a mean follow-up of 24 months (15-36 months). No patient suffered from infection, skin flap necrosis and X-ray showed there were no implants loosening or breakage. The mean AOFAS score was 88.4(47-100) and excellent and good result was 89.7%. The differences among Myerson classifications showed that there were statistical significance between type B and type A, type C (P<0.05) Three patients suffered from severe pain and difficult walking, X-ray showed the ambiguity of the joint space, which can be diagnosed as posttraumatic arthritis. One patient had arthrodesis finally.
: The Myerson classification is helpful to make preoperative plan and judging prognosis to the tarsometatarsal joint injuries. In type B, single or double incisions with screw or plate fixation is enough, while in type A and type C, double or triple incisions with screw or plate fixation in medial joints and Kirschner wire fixation in lateral joints are needed. Postoperatively, the type B patients had better prognosis than type A and type C patients. However, the concomitant injuries around the tarsometatarsal joint were not included in Myerson classification, which is the limitation but cannot be neglected.
Pakistan Journal of Medical Sciences Online 07/2014; 30(4):773-7. · 0.23 Impact Factor
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