The current treatment of displaced ligamentous injuries of the tarsometatarsal (TMT) joints is open reduction and rigid fixation using transarticular screws. This technique causes further articular surface damage that theoretically may increase the risk of arthritis. Should the screws break, hardware removal is difficult. An alternative method that avoids these potential complications is rigid fixation using dorsal plates.
The displacement between the first metatarsal and medial cuneiform, the second metatarsal and intermediate cuneiform, the first and second metatarsal bases, and the medial cuneiform and second metatarsal base were measured in 10 matched pairs of fresh-frozen cadaver lower extremities in the unloaded and loaded condition. After sectioning the Lisfranc and TMT joint ligaments, measurements were repeated in the loaded condition. The first and second TMT joints of the right feet were fixed with transarticular 3.5-mm cortical screws while those of the left feet with were fixed with dorsal 2.7-mm 1/4 tubular plates. Measurements were then repeated in the unloaded and loaded condition.
After ligament sectioning, significantly increased first and second TMT joint subluxation with loading was seen. No significant difference was noted with direct comparison between plates and screws with respect to ability to realign the first and second TMT joints and to maintain TMT joint alignment during loading. The amount of articular surface destruction caused by one 3.5-mm screw was 2.0 +/- 0.7% for the medial cuneiform, 2.6 +/- 0.5% for the first metatarsal, 3.6 +/- 1.2% for the intermediate cuneiform, and 3.6 +/- 1.0% for the second metatarsal.
The model reliably produced displacement of the first and second TMT joints consistent with a ligamentous Lisfranc injury. Transarticular screws and dorsal plates showed similar ability to reduce the first and second TMT joints after TMT and Lisfranc ligament transection and to resist TMT joint displacement with weightbearing load.
Dorsal plating may be an alternative to transarticular screws in the treatment of displaced Lisfranc injuries.
"Another alternative is the use of dorsal plates in treating Lisfranc injuries. This method avoids the potential complications associated with the use of screws, and produced early encouraging results   . K-wires should typically be removed after 6 weeks and before weight bearing in order to avoid them breaking . "
[Show abstract][Hide abstract] 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.
"Cortical screw fixation of the three medial TMT joints provides greater stability than K-wire fixation.12 But few authors suggest screw fixation for the fourth and fifth TMT joints, because this trans-articular fixation may aggravate the degeneration of the articular cartilage and accelerate the development of midfoot arthritis.27 But this controversial fixation method can be seen in some literatures. "
[Show abstract][Hide abstract] 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.
Pakistan Journal of Medical Sciences Online 04/2013; 29(2):687-692. DOI:10.12669/pjms.292.2996 · 0.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Symptomatic secondary osteoarthritis of the Lisfranc joints due to malunion following Lisfranc joint fracture dislocations
or ligamentous lesions at the Lisfranc and innominate joint level generally lead to a painful functional loss and a substantial
disturbance of the walking performance. Initially missed or inadequately addressed primary lesions still represent the major
source of Lisfranc joint malunions. Neuro-osteoarthropathic disorders may also become manifest in the Lisfranc joint region
and may be mistaken for truly posttraumatic consequences. Secondary osteoarthritis may be combined with typical multiplanar
deformities. The concept of a corrective arthrodesis includes restoration of stable physiologic axes and length proportions
of the foot columns. A standardized approach to analyze the clinical picture and corresponding pathomorphology and the transfer
into a comprehensive surgical concept which respects the realignment of any component of deformity is a prerequisite for a
good functional outcome and a high degree of patient satisfaction. A fusion limited to the medial three rays combined with
a soft tissue release may be sufficient for a favorable outcome in the majority of cases and preserve the mobility of the
two lateral rays.
Arthrodesis-Corrective osteotomy-Deformity-Lisfranc joint-Posttraumatic osteoarthritis
European Journal of Trauma and Emergency Surgery 06/2010; 36(3):217-226. DOI:10.1007/s00068-010-1068-8 · 0.35 Impact Factor
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