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. DOI: 10.1302/0301-620X.86B4.13761
Source: PubMed


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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Available from: James David Calder, Feb 02, 2014
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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.
    Full-text · Article · Dec 2014 · Injury
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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.
    Full-text · Article · Mar 2013 · Journal of Foot and Ankle Research
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    ABSTRACT: Abstract Lisfranc injuries affect at least 1 out of every 55,000 people each year. Although they are rare foot injuries, their effects can be devastating. 20-40% of Lisfranc injuries are missed upon first presentation. This increases the number of poor outcomes, resulting in a disproportionate number of malpractice lawsuits and compensation claims. The Kingston Brace was designed to support an injured foot during a CT scan with the goal of providing the diagnosing physician with the best diagnostic information possible. A prototype was designed and built to support a variety of foot orientations in order to determine which orientation is optimal for Lisfranc joint CT scanning. Three fresh frozen cadaver feet were put through several experiments with the Brace. The 2D diagnostic quality of CT scans taken using the Kingston Brace was compared against that of CT scans using the existing protocol. The Kingston Brace allows for a greater visualization of the injured Lisfranc joint than the existing CT protocol. Lisfranc joint spreading was used as a measure of potential pain in injured patients. The joint spreading was minimal, suggesting that injured patients would not feel as much additional pain during imaging. Also, the adoption of the Kingston Brace resulted in no change in the morphological parameters resulting from more advanced 3D analysis. The experimentally determined optimal Kingston Brace orientation was found to be 9, of eversion. These orientations can be incorporated into the next generation of Kingston Brace design. i Acknowledgments I would like to thank my two co-supervisors, Dr. Chris Mechefske and Dr. Kevin Deluzio.
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