Results of isolated Lisfranc injuries and the effect of compensation claims

Brisbane Foot and Ankle Centre, Arnold Janssen Centre, Brisbane Private Hospital, Brisbane, Queensland, Australia.
The Bone & Joint Journal (Impact Factor: 3.31). 06/2004; 86(4):527-30.
Source: PubMed

ABSTRACT The results of treatment of Lisfranc injuries are often unsatisfactory. This retrospective study investigated 46 patients with isolated Lisfranc injuries at a minimum of two years after surgery. Thirteen patients had a poor outcome and had to change employment, or were unable to find work as a result of this injury. The presence of a compensation claim (p = 0.02) and a delay in diagnosis of more than six months were associated with a poor outcome (p = 0.01). There was no association between poor functional outcome and age, gender, mechanism of injury or previous occupation. This study may have medico-legal implications on reporting the prognosis for such injuries, and highlights the importance of prompt diagnosis and treatment.

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    • "Delaying surgical treatment of Lisfranc injuries for over 6 months is associated with worse functional outcome [40]. There are several ways of measuring functional outcomes following a Lisfranc injury and a common one in use is the American Foot and Ankle Society (AOFAS) score. "
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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
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    • "Our data suggests that single leg standing with the foot 15° externally rotated provides a possible, clinically feasible position for Lisfranc ligament sonographic assessment. Similar to the radiographic protocols, patients presenting with acute pain from Lisfranc ligamentous injuries may not tolerate full weight-bearing, especially in an abducted position which appears to unlock the Lisfranc joint and renders it unstable [18]. A diagnostic nerve block could be administered prior to ultrasound evaluation to avoid patient guarding against weight-bearing. "
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    ABSTRACT: Background The Lisfranc ligament plays an integral role in providing stability to the midfoot. Variable clinical presentations and radiographic findings make injuries to the Lisfranc ligament notoriously difficult to diagnose. Currently, radiographic evaluation is the mainstay in imaging such injuries; however, ultrasound has been suggested as a viable alternative. The objective of this study was to evaluate the intra-rater and inter-rater reliability in the measurement of the length of the dorsal Lisfranc ligament using ultrasound imaging in healthy, asymptomatic subjects. Methods The dorsal Lisfranc ligaments of fifty asymptomatic subjects (n = 100 feet) were imaged using a Siemens SONOLINE Antares Ultrasound Imaging System© under low, medium, and high stress loads at 0° and 15° abducted foot positions. The lengths of the ligaments were measured, and Interclass correlation coefficients were used to calculate within-session intra-rater reliability (n = 100 feet) as well as between-session intra-rater reliability (n = 40 feet) and between-session inter-rater reliability (n = 40 feet). Results The within-session intra-rater reliability results for dorsal Lisfranc ligament length had an average ICC of 0.889 (min 0.873 max 0.913). The average ICC for between-session intra-rater reliability was 0.747 (min 0.607 max 0.811). The average ICC for between-session inter-rater reliability was 0.685 (min 0.638 max 0.776). Conclusions The measurement of the dorsal Lisfranc ligament length using ultrasound imaging shows substantial to almost perfect reliability when evaluating asymptomatic subjects. This imaging modality methodology shows promise and lays the foundation for further work in technique development towards the diagnostic identification of pathology within the Lisfranc ligament complex.
    Journal of Foot and Ankle Research 03/2013; 6(1):7. DOI:10.1186/1757-1146-6-7 · 1.46 Impact Factor
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    ABSTRACT: Lisfranc-Luxationen und -Luxationsfrakturen sind selten. Die Hardcastle- sowie die Myerson-Klassifikation sind im klinischen Alltag bewährt und gelten für die Charakterisierung des Verletzungstyps als gebräuchlich. Ligamentäre Stabilitäten können sowohl dynamisch als auch statisch radiologisch geprüft werden. Bei Nachweis einer Instabilität ist eine operative Therapie indiziert. Isolierte ligamentäre Instabilitäten werden häufig übersehen, und Begleitverletzungen sind häufig. Die Wahl zwischen geschlossenem vs. offenem Verfahren wird weiterhin kontrovers diskutiert, wobei sich eine primäre Arthrodese bei höhergradigen Verletzungen als vorteilhaft erwies. Die operative Therapie ist der konservativen in Bezug auf funktionelle Ergebnisse und Komplikationen überlegen. Artikuläre Kongruenz sowie anatomisches Alignment sind Determinanten für ein gutes funktionelles Outcome, dennoch ist eine erhöhte Morbidität charakteristisch. Implantate im Bereich der medialen Fußsäule können in situ verbleiben, im Bereich der lateralen Fußsäule dagegen müssen sie zur Freigabe essenzieller Gelenke frühzeitig entfernt werden. Komplikationen wie sekundäre Arthrosen, Implantatprobleme, Deformitäten sowie chronische Schmerzzustände sind häufig.
    Trauma und Berufskrankheit 06/2012; 14(2). DOI:10.1007/s10039-012-1890-9
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