Midterm functional outcomes in operatively treated adolescent Lisfranc injuries

Introduction: Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws. The aim of the present study was to provide short-term results of Lisfranc injuries treated with the suture button technique. Methods: Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated using the Mini Tight Rope® (Arthrex, Naples, FL). Medical records and radiographic images were analyzed with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up. Results: At a mean follow-up of 32 months, the average AOFAS score was 95.8 and the mean VAS was 0.6. All patients but one were able to return to their previous activities. A total of 9 complications were observed in 6 patients, with discomfort at the button insertion site being the most common (4). Other complications included evidence of radiographic arthritis (3), loss of reduction (1) and extensor hallucis longus tendinopathy (1). Only 1 patient required a reoperation for removal of the suture button. Conclusion: Use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.

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Functional Outcomes After Temporary Bridging With Locking Plates in Lisfranc Injuries

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2016.04.005 ◽

2016 ◽

Vol 55 (5) ◽

pp. 922-926 ◽

Cited By ~ 17

Author(s):

Paul J. van Koperen ◽

Vincent M. de Jong ◽

Jan S.K. Luitse ◽

Tim Schepers

Keyword(s):

Functional Outcomes ◽

Locking Plates ◽

Lisfranc Injuries

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Functional Outcomes of Open Reduction and Internal Fixation Treatment of Lisfranc Injuries

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00173 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0017

Author(s):

Daniel Corr ◽

Trevor McBride ◽

Ryan G. Rogero ◽

Steven M. Raikin ◽

Rachel J. Shakked

Keyword(s):

Internal Fixation ◽

Functional Outcomes ◽

Open Reduction ◽

Case Series ◽

High Energy ◽

Low Energy ◽

Foot And Ankle ◽

Lisfranc Injury ◽

Functional Scores ◽

Lisfranc Injuries

Category: Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Prior reports have suggested that primary partial arthrodesis may be superior to open reduction and internal fixation (ORIF) for the ligamentous Lisfranc injury. Although this may be true for the high energy Lisfranc injury, little has been studied regarding outcomes after operative fixation of low energy Lisfranc injuries. The purpose of this study is to present a large case series of patients who underwent ORIF for low energy ligamentous Lisfranc injuries including functional outcomes, complications, and reoperation rates. Methods: We included adult patients who underwent ORIF for low-energy Lisfranc injuries with fellowship-trained foot and ankle surgeons at our institution within 6 weeks of injury. Patients were excluded if the mechanism of injury or initial radiographs were consistent with a high-energy mechanism such as significant subluxation of multiple tarsometatarsal joints rather than subtle diastasis with weight-bearing images. Patients were also excluded if there were any significant fractures aside from avulsion fractures, other associated injuries, or underlying neuropathic pathophysiology. Patients completed the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales, Visual Analog Scale for Pain (VAS), and Short Form-12 questionnaires before their procedures and then at least 2 years post-operatively. Standard demographic data was collected. Spearman’s correlations and Student’s t-tests were performed to evaluate outcomes after surgery and any relationship between patient characteristics and functional scores. Results: Eighty-seven patients completed functional scores an average of 4.9 years following their procedure (range 2.0 - 8.9), with average age of 41 and average BMI of 27.5. Fifty-two patients (59.8%) were female, and average time from injury to procedure was 15.2 days (range 1-36). Average FAAM-ADL improved from 27.83 to 88.36 postoperatively (p<.001), average FAAM-Sports improved from 7.47 to 76.36 (p<.001), and average VAS pain rating was reduced from 62.83 to 21.78 (p<.001). Hardware removal was performed in 36 cases (41.4%). One patient required removal of hardware and revision ORIF 30 days after the index procedure as a result of hardware complication. Both age at the time of surgery and BMI were negatively correlated with followup SF-12 Physical Health scores (r=-0.254, p=0.018; r=-0.263, p=0.014 respectively). Conclusion: This study is one of the largest case series of low energy Lisfranc injuries. We demonstrate that ORIF for low- energy Lisfranc injuries results in significant functional improvement and pain reduction while maintaining low rates of loss of correction or reoperation. Further investigation is necessary to evaluate this subset of Lisfranc injuries in terms of optimal surgical treatment patient functional outcomes following the use of primary arthrodesis in the treatment of Lisfranc procedures, and to assess the efficacy of the various hardware choices available for the procedure. [Table: see text]

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Short-Term Results of Lisfranc Injuries Treated with the Suture Button Technique

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00371 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0037

Author(s):

Guilherme H. Saito ◽

Alberto A. M. Mendes ◽

Danilo R. C. Nishikawa ◽

Beatriz Devito ◽

Cesar de Cesar Netto ◽

...

Keyword(s):

Functional Outcomes ◽

Articular Surface ◽

Insertion Site ◽

Hardware Removal ◽

Short Term ◽

Suture Button ◽

Loss Of Reduction ◽

The Mean ◽

Lisfranc Injuries

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Primary fixation with screws or plates or primary arthrodesis are considered the gold-standard surgical treatment options for Lisfranc injuries. However, drawbacks of these procedures include loss of joint motion, need for later hardware removal, injury of the articular surface by screws and nonunion. Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws and minimize the harm to the joint cartilage. The aim of the present study was to provide the short-term results of Lisfranc injuries treated with the suture button technique. Methods: Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated with the use of the Mini Tight Rope (Arthrex, Naples, FL) between April 2014 and November 2017. Medical records and radiographic images were retrospectively analyzed by independent observers with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 (range, 6-49) months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up. Results: At a mean follow-up of 32 months, the average AOFAS score was 95.8 (range, 82-100) and the mean VAS was 0.6 (range, 0-2). All patients but one were able to return to their previous activities. Twelve patients were very satisfied with the outcomes and four were satisfied or partially satisfied. A total of 9 complications were observed in 6 patients, with discomfort on the button insertion site being the most common (4 cases). Other complications included evidence of radiographic arthritis (3 cases), loss of reduction (1 case) and extensor hallucis longus tendinopathy (1 case). Only 1 patient required a reoperation for removal of the suture button. Conclusion: The use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. This technique is potentially less harmful to the articular cartilage and generally does not require hardware removal. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.

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