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

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.

scholarly journals Surgical Outcomes after Simple Coalition Bar Excision in Naviculo-Medial Cuneiform Coalition in Adults

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0029
Author(s):  
Jaeyoung Kim ◽  
Jonathan Day ◽  
Woo-Chun Lee
Keyword(s):  
Demographic Data ◽  
Weight Bearing ◽  
Rare Condition ◽  
Considerable Proportion ◽  
X Rays ◽  
Morphological Pattern ◽  
Abnormal Finding ◽  
Medial Cuneiform ◽  
Patient Reported

Category: Midfoot/Forefoot; Other Introduction/Purpose: Coalition of the naviculo-medial cuneiform joint (NCJ) is a relatively rare condition among the tarsal bone coalitions. Thus, optimal treatment is still largely unknown. There is a paucity of literature, with few cases documenting arthrodesis of the NCJ in adults with varied outcomes. As the NCJ contributes to the majority of motion along the medial column of the foot, arthrodesis of the joint may cause excessive stress on adjacent joints. Furthermore, the nonunion rate of NCJ is reportedly high, ranging from 3 to 15%. The purpose of this study was to report the outcomes of simple coalition bar excision in patients with NCJ coalition. Additionally, we investigated preoperative abnormal conditions around the NCJ using weight bearing computed tomography (WBCT). Methods: We retrospectively identified 21 feet in 18 prospectively followed patients from 2010 to 2018 who underwent simple coalition bar excision of NCJ in our institution. Chart review was performed to retrieve demographic data of the patients, clinical presentation findings, and concomitant procedures with coalition bar excision. Radiographically, the location and morphological pattern of the coalition were analyzed. Several angular parameters including medial arch sag angle (MASA) were measured on weightbearing x-rays to see if there are any angular collapse at NCJ after coalition bar excision (Figure 1). The existence of abnormal conditions adjacent to the NCJ such as arthritis of the first and second tarsometatarsal joint (TMTJ) and talonavicular joint (TNJ) were assessed using WBCT (n=17). Clinically, pre- and postoperative visual analogue scale (VAS) and foot function index (FFI) were compared to assess for improvement in patient-reported outcomes. Results: The mean age of the patients was 30.9 years (range, 16-62) and the follow-up was 15.9 months (range, 12-24). Majority of the patient had fibrous coalition at the plantar-medial aspect and only one patient had bony coalition. The morphology of fibrous coalition was classified as irregular (n=8), cystic (n=1), and combined (n=11) based on CT findings. Intraoperatively, the motion of the NCJ was identified in every patient after coalition bar excision. WBCT revealed 15 feet (71.4%) having at least one abnormal finding around the NCJ (First TMTJ plantar gap; n=10, second TMTJ narrowing; n=9, first TMTJ spur & irregularity; n=2, TNJ spur; n=1). Pre- and postoperative MASA did not change significantly (p=0.932). There was significant improvement in VAS and FFI at final follow-up (p<0.001) Conclusion: A considerable proportion of patients with NCJ coalition had at least one radiographically arthritic feature at adjacent joints preoperatively, which may be caused by the restriction in motion associated with NJC coalition. Simple coalition bar excision in adults resulted in satisfactory outcomes without NC joint angular deterioration, while restoring motion at the joint.

scholarly journals Non-restricted weight-bearing after modified Lapidus arthrodesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Manuel Pellegrini ◽  
Giovanni Carcuro ◽  
Natalio Cuchacovic ◽  
Gerardo Muñoz ◽  
Marcelo Somarriva
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Clinical Results ◽  
Delayed Union ◽  
Rigid Fixation ◽  
X Rays ◽  
Non Union ◽  
Fixation Methods ◽  
First Ray

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Modified lapidus arthrodesis is performed in the treatment of different pathologies, including hallux valgus and osteoarthritis of the first cuneo-metatarsal joint. Complications of this procedure include delayed union and non-union, reported to be between 5 to 20%. To prevent them, prolonged foot unloading and rigid fixation methods have been proposed. We sought to investigate our clinical results and complications in patients operated on with a modified Lapidus arthrodesis and inmediate weight bearing in a rigid post-operative shoe. Methods: After IRB approval, we conducted a retrospective patient chart review in a single center. Dedicated foot and ankle orthopaedic surgeons performed all procedures. Patients were included if they were older than 18 years, had a minimum follow up of one year and agreed to participate in the study. Patients with neuropathy, revision arthrodesis or those with concomitant midfoot/hindfoot procedures were excluded. All patients were operated on with an inter-articular lag screw and a locking neutralization plate. Patients were allowed to weight bear without restriction in a rigid post-operative shoe from postoperative day one. An independent musculoskeletal radiologist evaluated bone consolidation of the arthrodesis in x-rays or CT scan, when available. Results: Fifteen patients (18 feet) with an average age of 47 years (15-66) met inclusion criteria. All patients were female. Mean follow up was 19 months (12-24). Surgical indications were: hallux valgus in 14 cases and cuneo-metatarsal osteoarthritis in one case. Consolidation rate was 94% (14/15). Average time for radiological consolidation was 11 weeks (7-27). One patient (6%) developed non-union and required a revision arthrodesis with bone grafting. No loss of radiological correction or malalignment of the first ray was observed at last follow-up. Conclusion: Our results suggest that modified lapidus arthrodesis with rigid fixation methods and non restricted weight bearing is a safe and effective alternative to manage first ray pathology. This approach may not increase non-union rates or affect the reduction obtained.

scholarly journals Monteggia fracture dislocation in adults: study of functional outcome following surgical treatment in patients attending a tertiary care center in North India

2017 ◽  
Vol 5 (7) ◽  
pp. 2975
Author(s):  
Shameem A. Khan
Keyword(s):  
Functional Outcome ◽  
Radial Head ◽  
Closed Reduction ◽  
Fracture Dislocation ◽  
Monteggia Fracture ◽  
Rigid Fixation ◽  
X Rays ◽  
Compression Plate ◽  
Monteggia Fracture Dislocation ◽  
Mean Time

Background: Monteggia fracture dislocations are rare injuries that comprise less than five percent of all forearm fractures. Good results in monteggia fractures depend on early and accurate diagnosis, rigid fixation of ulna, accurate reduction of radial head and post-operative immobilization to allow ligamentous healing about the dislocated radial head. The objectives of the study were to assess the mean time taken for union of fracture, complication encountered during treatment, to assess the functional outcome and to present conclusions based on the results of plate osteosynthesis of monteggia fracture dislocation in adults.Methods: In a prospective study from September 2013 to August 2016, twenty adult patients of monteggia fracture were admitted and treated by closed reduction/excision of radial head and compression plate fixation of ulna. The results were evaluated by assessing union on serial x-rays at follow-up (6-18 months) and functional outcome using Anderson’s criteria.Results: Most of the cases were type-1 fracture-dislocation according to Bado's classification. Mean time taken for union was 4.1 months. Using Anderson scoring system, we achieved 65% excellent results, 30% satisfactory result and 5% failure in study case. The complication encountered were superficial infection and non-union.Conclusions: The technique of early closed reduction of radial head and open reduction and internal fixation of ulna using compression plate is a simple and effective means of treating monteggia fracture dislocation in adults with excellent functional outcome. Upper limb should be immobilized in 110-120 degrees of elbow flexion and forearm in supination to prevent radial head redislocation.

scholarly journals ROLE OF PHYSICAL THERAPY IN THE TREATMENT OF POSTERIOR ANKLE IMPINGEMENT IN PEDIATRIC ATHLETES - A PROSPECTIVE STUDY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0008
Author(s):  
Adam Saloom ◽  
Nick Purcell ◽  
Matthew Ruhe ◽  
Jorge Gomez ◽  
Jonathan Santana ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Prospective Study ◽  
Conservative Management ◽  
Pediatric Patients ◽  
Weight Bearing ◽  
Return To Sport ◽  
Time To Surgery ◽  
Ankle Impingement ◽  
Posterior Ankle Impingement

Background: Posterior ankle impingement (PAI) is a known cause of posterior ankle pain in athletes performing repetitive plantarflexion motion. Even though empirically recommended in adult PAI, there is minimal literature related to the role of conservative physical therapy (PT) in pediatric patients. Purpose: To identify patient characteristics and determine if there is a difference in pediatric patients with PAI who were successful with conservative PT and those who were unsuccessful, requiring surgical intervention. Methods: Prospective study at a tertiary children’s hospital included patients <18 years diagnosed with PAI and underwent PT. Patients who received PT at an external facility were excluded. Collected data included demographics, initial presentation at PT evaluation, treatment throughout PT, patient presentation at PT discharge, time to return to sport (RTS) from initial PT evaluation (if successful), time to surgery from initial PT evaluation (if unsuccessful). Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were collected. Group comparisons were conducted using independent t-tests or chi-square analyses (alpha level set at .05). Results: 31 (12 males, 19 females) patients diagnosed with PAI were enrolled with a mean age 12.61 years (range: 8-17). Gymnastics, football, and basketball were the most commonly implicated sports (42% patients). All patients underwent initial conservative PT for an average of 16.24 weeks (9.23 visits ±7.73). 20/31(64.5%) patients failed conservative management and underwent arthroscopic debridement. PAI pathology was predominantly bony in 61.3% and soft tissue 38.7%. Between the successful PT group and unsuccessful PT group, there was no difference in the proportion of athletes/non-athletes (p=.643). Average RTS time for successful group was 11.47 weeks and average time to surgery for unsuccessful group was 17.82 weeks. There were no significant differences in sex (p=.332), age (p=.674), number of PT visits (p=.945), initial weight-bearing status (p=.367), use of manual therapy (p=.074) including manipulation (p=.172) and mobilization (p=.507), sport (p=.272), initial evaluation ankle ROM (p>.05). Initial AOFAS scores for pain, function, alignment, or total were not significantly different (p=.551, .998, .555, .964 respectively). Conclusion: The first prospective study in pediatric patients with PAI demonstrates that even though success of PT is not dependent on age, sex, sport or PAI pathology, a notable proportion of patients who undergo PT do not need surgery. Conservative management including PT should be the initial line of management for PAI. PT treatment and surgery (if unsuccessful with PT) allowed patients to return to prior level of activity/sports. Tables/Figures: [Table: see text]

Key comparison BIPM.RI(I)-K2 of the air-kerma standards of the LNE–LNHB, France and the BIPM in low-energy x-rays

Metrologia ◽  
2011 ◽  
Vol 48 (1A) ◽  
pp. 06013-06013 ◽  
Author(s):  
D T Burns ◽  
P Roger ◽  
M Denozière ◽  
E Leroy
Keyword(s):  
Low Energy ◽  
X Rays ◽  
Key Comparison ◽  
Air Kerma

scholarly journals The use of fricke dosimetry for low energy x-rays

2006 ◽  
Vol 49 (spe) ◽  
pp. 17-23 ◽  
Author(s):  
Carlos de Austerlitz ◽  
Viviane Souza ◽  
Heldio Pereira Villar ◽  
Aloisio Cordilha
Keyword(s):  
Ionization Chamber ◽  
Parallel Plate ◽  
Low Energy ◽  
Calibration Factor ◽  
X Rays ◽  
Measuring Systems ◽  
X Ray ◽  
Dose Measurements

The performance of four X-ray qualities generated in a Pantak X-ray machine operating at 30-100 kV was determined with a parallel-plate ionization chamber and a Fricke dosimeter. X-ray qualities used were those recommended by Deutsch Internationale Normung DIN 6809 and dose measurements were carried out with Plexiglas® simulators. Results have shown that the Fricke dosimeter can be used not only for soft X-ray dosimetry, but also for the maintenance of low-energy measuring systems' calibration factor.

Investigation of gas generation in regenerative fuel cells by low-energy X-rays

2015 ◽  
Vol 296 ◽  
pp. 133-141 ◽  
Author(s):  
Omer Faruk Selamet ◽  
Phengxay Deevanhxay ◽  
Shohji Tsushima ◽  
Shuichiro Hirai
Keyword(s):  
Fuel Cells ◽  
Low Energy ◽  
X Rays ◽  
Gas Generation
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