Flexible Fixation Treatment Strategies for Low-energy Lisfranc Injuries

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Open reduction and internal fixation (ORIF) with transarticular screws or bridge plating is the standard of care for unstable Lisfranc injuries. There are no studies comparing the clinical outcomes of fixation with transarticular screws or bridge plates in young, athletic patients who sustained low-energy injuries. Methods: All low-energy Lisfranc injuries that underwent ORIF between 2010 and 2015 were reviewed. Injuries were classified as low-energy if the occurred during athletic activity, ground level twisting, or a fall from less than three feet (typically stairs or curbs). Tarsometatarsal (TMT) joint fixation with transarticular screws or bridge plating was documented. Transarticular screws were typically removed between four and six months postoperatively. Injury characteristics, complication rates, pain scores, and Foot and Ankle Ability Measure (FAAM) scores were compared. All continuous variables were compared with a two-tailed Student t-test. All categorical variables were compared using the Chi Squared test. Results: Of the fifteen patients identified, nine were fixed with transarticular screws and six with bridge plates. Average patient age was 27 years old. 12 of 15 were primarily ligamentous injuries. Implant removal was performed in the entire transarticular screw group and three out of six in the bridge plate group (p=0.018). Secondary arthrodesis for arthritis was recommended in two of the transarticular screw group and none of the bridge plate group (p=0.21). Mean FAAM scores were significantly higher in all subscales (ADL 96.2 v 76.7 p=.035, ADL SANE 92.5 v 72.6 p=.055, Sport 89.5 v 62.5 p=.027, Sport SANE 90 v 58.7 p=.024) in the bridge plate group at an average of 43 months follow up. Conclusion: In this study, ORIF with bridge plate fixation of the TMT joints had a lower rate of HWR and higher medium term FAAM scores than fixation with transarticular screws. A statistically significant difference in rates of secondary arthritis could not be established in this small cohort. Prospective studies are necessary to confirm these findings.

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Percutaneous Reduction and 2.7-mm Cortical Screw Fixation for Low-Energy Lisfranc Injuries

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2019.10.013 ◽

2020 ◽

Vol 59 (5) ◽

pp. 914-918 ◽

Cited By ~ 1

Author(s):

Young Hwan Park ◽

Jeong Hwan Ahn ◽

Gi Won Choi ◽

Hak Jun Kim

Keyword(s):

Screw Fixation ◽

Low Energy ◽

Percutaneous Reduction ◽

Cortical Screw ◽

Lisfranc Injuries

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Low-Energy Lisfranc Injuries in an Athletic Population

Foot and Ankle Clinics ◽

10.1016/j.fcl.2018.07.014 ◽

2018 ◽

Vol 23 (4) ◽

pp. 679-692 ◽

Cited By ~ 3

Author(s):

Mario I. Escudero ◽

Michael Symes ◽

Andrea Veljkovic ◽

Alastair S.E. Younger

Keyword(s):

Low Energy ◽

Athletic Population ◽

Lisfranc Injuries

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Advances in Computational Radiation Biophysics for Cancer Therapy: Simulating Nano-Scale Damage by Low-Energy Electrons

Biophysical Reviews and Letters ◽

10.1142/s1793048014500040 ◽

2015 ◽

Vol 10 (01) ◽

pp. 25-36 ◽

Cited By ~ 6

Author(s):

Zdenka Kuncic

Keyword(s):

Molecular Level ◽

Discrete Event ◽

Treatment Strategies ◽

Low Energy ◽

Significant Advance ◽

Biological Damage ◽

Microbeam Radiation Therapy ◽

Low Energy Electrons ◽

Radiation Induced ◽

Thermodynamic Phase

Computational radiation biophysics is a rapidly growing area that is contributing, alongside new hardware technologies, to ongoing developments in cancer imaging and therapy. Recent advances in theoretical and computational modeling have enabled the simulation of discrete, event-by-event interactions of very low energy (≪ 100 eV) electrons with water in its liquid thermodynamic phase. This represents a significant advance in our ability to investigate the initial stages of radiation induced biological damage at the molecular level. Such studies are important for the development of novel cancer treatment strategies, an example of which is given by microbeam radiation therapy (MRT). Here, new results are shown demonstrating that when excitations and ionizations are resolved down to nano-scales, their distribution extends well outside the primary microbeam path, into regions that are not directly irradiated. This suggests that radiation dose alone is insufficient to fully quantify biological damage. These results also suggest that the radiation cross-fire may be an important clue to understanding the different observed responses of healthy cells and tumor cells to MRT.

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Injury Characteristics of Low-Energy Lisfranc Injuries Compared With High-Energy Injuries

Foot & Ankle International ◽

10.1177/1071100717709575 ◽

2017 ◽

Vol 38 (9) ◽

pp. 964-969 ◽

Cited By ~ 17

Author(s):

Christopher H. Renninger ◽

Grant Cochran ◽

Trevor Tompane ◽

Joseph Bellamy ◽

Kevin Kuhn

Keyword(s):

Motor Vehicle ◽

High Energy ◽

Motor Vehicle Crash ◽

Low Energy ◽

Future Research ◽

Injury Patterns ◽

Lisfranc Joint ◽

Lateral Column ◽

Articular Fractures ◽

Lisfranc Injuries

Background: Lisfranc injuries result from high- and low-energy mechanisms though the literature has been more focused on high-energy mechanisms. A comparison of high-energy (HE) and low-energy (LE) injury patterns is lacking. The objective of this study was to report injury patterns in LE Lisfranc joint injuries and compare them to HE injury patterns. Methods: Operative Lisfranc injuries were identified over a 5-year period. Patient demographics, mechanism of injury, injury pattern, associated injuries, missed diagnoses, clinical course, and imaging studies were reviewed and compared. HE mechanism was defined as motor vehicle crash, motorcycle crash, direct crush, and fall from greater than 4 feet and LE mechanism as athletic activity, ground level twisting, or fall from less than 4 feet. Thirty-two HE and 48 LE cases were identified with 19.3 months of average follow-up. Results: There were no differences in demographics or missed diagnosis frequency (21% HE vs 18% LE). Time to seek care was not significantly different. HE injuries were more likely to have concomitant nonfoot fractures (37% vs 6%), concomitant foot fractures (78% vs 4%), cuboid fractures (31% vs 6%), metatarsal base fractures (84% vs 29%), displaced intra-articular fractures (59% vs 4%), and involvement of all 5 rays (23% vs 6%). LE injuries were more commonly ligamentous (68% vs 16%), with fewer rays involved (2.7 vs 4.1). Conclusions: LE mechanisms were a more common cause of Lisfranc joint injury in this cohort. These mechanisms generally resulted in an isolated, primarily ligamentous injury sparing the lateral column. Both types had high rates of missed injury that could result in delayed treatment. Differences in injury patterns could help direct future research to optimize treatment algorithms. Level of Evidence: Level III, comparative series.

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Outcomes After Percutaneous Reduction and Fixation of Low-Energy Lisfranc Injuries

Foot & Ankle International ◽

10.1177/1071100717706154 ◽

2017 ◽

Vol 38 (7) ◽

pp. 710-715 ◽

Cited By ~ 18

Author(s):

Michael Vosbikian ◽

Joseph T. O’Neil ◽

Christine Piper ◽

Ronald Huang ◽

Steven M. Raikin

Keyword(s):

Minimally Invasive ◽

Motor Vehicle ◽

Case Series ◽

Low Energy ◽

Invasive Technique ◽

Functional Level ◽

Percutaneous Reduction ◽

Objective Evidence ◽

Lisfranc Injuries

Background: Lisfranc injuries are often missed initially or not anatomically reduced, leading to midfoot collapse, arthrosis, and pain. Operative management of these injuries is also fraught with complications, particularly with respect to the soft tissues. Wound dehiscence and infection are not uncommon. The goal of this study was to analyze the outcomes of a minimally invasive technique in reduction and percutaneous fixation of low-energy minimally displaced Lisfranc injuries and determine if it is a safe alternative to more traditional, open approaches. Methods: A retrospective review was performed for all patients who underwent minimally invasive Lisfranc treatment at a single institution over a 6-year period. Thirty-eight patients were identified in this series. All patients were skeletally mature and had a minimum follow-up of 3 years. Patients were assessed clinically and radiographically, in addition to undertaking patient-centric outcome scoring using the Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL) and sports subscales at a mean follow-up of 66 months (range, 36-100). Patients were also asked to subjectively rate their percentage return to preinjury functional level at the time of final follow-up. There were 20 males and 18 females. Seventeen patients were injured participating in sports-related activities, 19 during falls, and 2 as a result of motor vehicle accidents. The average age at the time of surgery was 34.2 (range, 16-69) years. At final follow-up, 31 patients were available for assessment (81.6%). Results: The mean FAAM-ADL score was 94.2 (range, 40.5-100), and sports score was 90.4 (range, 0-100). Percentage recovery compared to their preinjury functional level averaged 91.4% (range, 40%-100%). There were no complications in this series. Twenty-two patients underwent screw removal electively at an average of 6.9 months following the index procedure. No patients had undergone any additional operative procedures, or had any objective evidence of midfoot collapse or arthritis at the time of final follow-up. Conclusion: Minimally invasive methods of treating low-energy Lisfranc injuries with less soft tissue stripping and disruption, as described in this series, were a valuable tool to optimize outcomes while minimizing the potential morbidity of more traditional, open techniques. Level of Evidence: Level IV, retrospective case series.

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Homolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study

Video Journal of Sports Medicine ◽

10.1177/26350254211042885 ◽

2021 ◽

Vol 1 (6) ◽

pp. 263502542110428

Author(s):

Steven R. Dayton ◽

Kurt M. Krautmann ◽

Michael J. Boctor ◽

Vehniah K. Tjong ◽

Anish R. Kadakia

Keyword(s):

Weight Bearing ◽

Return To Sport ◽

Low Energy ◽

Fracture Dislocation ◽

Rigid Fixation ◽

X Rays ◽

Medial Cuneiform ◽

The Wire ◽

High Level ◽

Lisfranc Injuries

Background: Lisfranc injuries encompass a spectrum of injuries to the tarsometatarsal (TMT) joint complex from ligamentous sprains to fractures with dislocation. While studies have shown it is possible to return to sport (RTS) after low-energy injuries, no literature exists demonstrating RTS after homolateral fracture/dislocation of all 5 metatarsals. Indications: We present a novel technique for repair of homolateral Lisfranc fracture/dislocation of metatarsals 1-5 which may be used in high-level athletes attempting to return to competition. Technique Description: A dual approach is utilized, with a dorsal approach to allow for fusion of the 2nd and 3rd TMT joints and medial approach for internal bracing of the 1st TMT joint. The 2nd and 3rd metatarsals were denuded of all cartilage and the fusion site was fully prepared. Rigid fixation was applied to the fusion sites and then stability of the 1st TMT was reassessed. A guidewire for the cannulated InternalBrace (Arthrex; Naples, FL) system is initially inserted into the base of the 1st metatarsal. Positioning is confirmed with fluoroscopic imaging and the 3.4 mm drill is passed over the wire, followed by the cannulated tap. A 4.75 mm SwiveLock anchor (Arthrex; Naples, FL) with FiberTape suture (Arthrex; Naples, FL) is then inserted into the metatarsal base. The guidewire is placed in a reciprocating position on the medial cuneiform. The 2.7 mm drill is passed over the wire, followed by the 3.5 mm tap. A 3.5 mm SwiveLock anchor is then loaded with the FiberTape suture from the 1st metatarsal. Tensioning is performed, and the 3.5 mm SwiveLock anchor is inserted into the medial cuneiform. Results: The athlete was cleared to return to full competition 9 months following surgery. Physical examination demonstrated stability in dorsiflexion and abduction. Both weight-bearing x-rays and computed tomography scans showed no evidence of hardware failure, no instability of the 1st TMT joint, and solid fusion of the 2nd and 3rd TMT joints. Discussion/Conclusion: Current literature demonstrates that RTS is possible for athletes suffering from low-energy Lisfranc injuries. This novel surgical technique is the first to demonstrate return to sport of a high-level athlete from homolateral fracture/dislocation of all 5 metatarsals.

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