Article

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.
Journal of Bone and Joint Surgery - British Volume (Impact Factor: 2.8). 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.

0 Bookmarks
 · 
379 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Le lesioni dell’articolazione tarso-metatarsale sono note per le difficoltà di diagnosi, di trattamento e per l’elevato tasso di esiti invalidanti. Sono stati proposti diversi tipi di trattamento per queste lesioni; i dati presenti in letteratura non sono univoci nella definizione della qualità della ripresa funzionale. Scopo di questo lavoro è presentare i risultati ottenuti nella nostra esperienza, confrontandoli con quelli presenti in letteratura al fine di definire un possibile algoritmo terapeutico. Sono stati inclusi solo pazienti con fratturalussazione o lussazione pura della Lisfranc, escludendo i politraumi e i casi con concomitanti lesioni a carico dell’arto inferiore o con esposizione. In base a quanto osservato, possiamo affermare che: le lesioni della Lisfranc andrebbero trattate con una riduzione a cielo aperto seguita da sintesi interna; la riduzione a cielo chiuso seguita dalla stabilizzazione percutanea è giustificata solo in caso di problemi cutanei o vascolari legati al trauma o a patologie preesistenti; l’artrodesi primaria rappresenta il trattamento di scelta nelle fratture altamente comminute. Riteniamo che l’ORIF continui a ricoprire il ruolo principale nel trattamento delle lesioni della Lisfranc, mentre l’artrodesi debba essere considerata prevalentemente come un intervento di salvataggio.
    Aggiornamenti CIO. 12/2012; 18(2).
  • Source
    [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.
    Injury 12/2014; 46. · 2.46 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Tibial plateau fractures (TPFs) are an independent, non-modifiable risk factor for surgical site infections (SSIs). Current antero-lateral approaches to the knee dissect through the anterior tibial angiosome (ATA), which may contribute to a higher rate of SSIs. The aim of this study was to develop an angiosome-sparing antero-lateral approach to allow reduction and fixation of lateral TPFs and to investigate its feasibility in a consecutive cohort. Twenty cadaveric knees were dissected to define the position of the vessels supplying the ATA from the lateral tibial condyle to the skin perforators. Based on these results, an angiosome-sparing surgical approach to treat lateral TPFs was developed. Fifteen consecutive patients were subsequently treated through this approach. Clinical outcomes included assessment of SSI and Lysholm score. Fracture healing and stability were assessed using the Rasmussen score and radiostereometric analysis (RSA). At the latest follow-up between 1 and 4 years, there was no report of SSI. Nine patients (60%) had good or excellent Lysholm scores. The mean Rasmussen score at final follow-up was 17 (median 18, range 14-18) with 10 patients (66%) graded as excellent. Fracture fragment migration measured using RSA was below 2mm in all cases. This study has demonstrated that an angiosome-sparing antero-lateral approach to the lateral tibial plateau is feasible. Adequate stability of these fracture types was achieved by positioning a buttress plate away from the bone and superficial to the regional fascial layer as an 'internal-external fixator'. The angiosome-sparing approach developed was able to be used in a prospective cohort and the clinical results to date are encouraging. Future clinical studies need to investigate the potential benefits of this surgical approach when compared with the previously described antero-lateral approaches.
    Injury 12/2013; · 2.46 Impact Factor

Full-text (2 Sources)

Download
127 Downloads
Available from
May 30, 2014