Single Stage Surgery for Open Lisfranc Injury: A Case Report

Management of open Lisfranc injuries is challenging. The improper management of the injuries might lead to bad results like skin necrosis and arthritis of Lisfranc’s joints. A case of Myerson type A Gustilo Grade IIIB open Lisfranc injury was managed with single stage debridement and internal fixation. At three years follow-up, the result was excellent with American Orthopedic Foot and Ankle Society (AOFAS) midfoot score of 100 and the patient had rejoined his previous occupation requiring prolonged walking.

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A Comparison of Complications and Reoperations Between Open Reduction and Internal Fixation Versus Primary Arthrodesis Following Lisfranc Injury

Foot & Ankle Specialist ◽

10.1177/19386400211058264 ◽

2021 ◽

pp. 193864002110582

Author(s):

Eric So ◽

Jonathan Lee ◽

Michelle L. Pershing ◽

Anson K. Chu ◽

Matthew Wilson ◽

...

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Retrospective Chart Review ◽

Reoperation Rate ◽

Complication Rates ◽

Lisfranc Injury ◽

Significant Difference ◽

Lisfranc Injuries ◽

Reoperation Rates

There is a lack of consensus in the literature regarding optimal treatment methods for Lisfranc injuries, and recent literature has emphasized the need to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA). The purpose of the current study is to compare reoperation and complication rates between ORIF and PA following Lisfranc injury in a private, outpatient, orthopaedic practice. A retrospective chart review was performed on patients undergoing operative intervention for Lisfranc injury between January 2009 and September 2015. A total of 196 patients met the inclusion criteria (130 ORIF, 66 PA), with a mean follow-up of 61.3 and 81.7 weeks, respectively. The ORIF group had a higher reoperation rate than the PA group, due to hardware removal. When hardware removals were excluded, the reoperation rate was similar. Postsurgical complications were compared between the 2 groups with no significant difference. In conclusion, ORIF and PA had similar complication rates. When hardware removals were excluded, the reoperation rates were similar, although hardware removals were more common in the ORIF group compared with the PA group. Levels of Evidence: Level III

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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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Primary Arthrodesis Compared with Open Reduction and Internal Fixation for Lisfranc Injuries with the First Tarsometatarsal Joint Dislocation

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00132 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0013

Author(s):

Ming-Zhu Zhang ◽

Guang-rong Yu ◽

Mark Myerson

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Bodily Pain ◽

Open Reduction Internal Fixation ◽

Term Outcome ◽

Lisfranc Injury ◽

Joint Dislocation ◽

Sf 36 ◽

First Ray ◽

Lisfranc Injuries

Category: Trauma Introduction/Purpose: The first tarsometatarsal (TMT) joint is very crucial for midfoot stability. To address its importance, retrospective analyses of treatment for the first TMT joint dislocation with Lisfranc injury was performed in a multi-center manner. Comparison of open reduction internal fixation (ORIF) and primary arthrodesis was conducted for the injury. Methods: This multi-center study was involved ten clinical institutions in different area of China. .From January 2003 to June 2015, 126 Lisfranc injuries with first TMT joint dislocation underwent surgical intervention. Of this group, forty one (32.5%) feet were first TMT joint dislocation only. Eighty five feet were first TMT joint dislocation and fractures. They were 76 males (60.3%) and 50 females (39.7%) with a mean age of 45.5 (range, 20-87) years. The duration from injury to surgery is 11.7 (range, 4-26) days. Two groups were divided by surgery methods as open reduction internal fixation (ORIF) group and primary arthrodesis group. Ninety two patients were performed by ORIF, while primary arthrodesis group including 34 cases. Outcome measures included clinical examination, radiographs, AOFAS ankle-hindfoot scores, visual analogue scale (VAS) and SF-36 scores. Complications and revision rate were analyzed as well. Results: 126 patients were followed up for 29.5 months. At 1.5 years postoperatively, the AOFAS score was 79 and 85 in ORIF group and arthrodesis group.The VAS score was 3.1 separately in two groups.The mean Physical Functioning sores of SF-36 was 80.3 points and 83.5• points. The Bodily Pain score of SF-36 was 76.1 points and 84.6• points.Redislocation of first tarsometarsal joint were observed in 16 cases among ORIF group.36 patients in ORIF group had pain in midfoot, eight of them had persistent pain with the development of deformity or osteoarthrosis.No redislocation and no hardware failure was identified in arthrodesis group Conclusion: Primary stable arthrodesis of the first ray gives a better short and medium term outcome than open reduction and internal fixation for Lisfranc injury with the first ray dislocation. Possible complication and revision could be avoided by primary arthrodesis for dislocated first ray injuries.

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Primary Arthrodesis Compared with Open Reduction and Internal Fixation for Lisfranc Injuries with the First Tarsometatarsal Joint Dislocation: A Randomized Controlled Trial

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00078 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0007

Author(s):

Mingzhu Zhang ◽

Guangrong Yu

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Controlled Trial ◽

Bodily Pain ◽

Lisfranc Injury ◽

Joint Dislocation ◽

Tarsometatarsal Joint ◽

Sf 36 ◽

First Ray ◽

Lisfranc Injuries

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Prospective analyses of treatment for the first tarsometatarsal joint dislocation with Lisfranc injury. Comparison of open reduction internal fixation (ORIF) and primary arthrodesis was conducted for the injury. Methods: 78 Lisfranc injuries with first tarsometatarsal joint dislocation underwent surgical intervention. They were 46 males and 32 females with mean age of 41.2 years. Two groups were randomized by ORIF group and primary arthrodesis group. 43 patients were performed by ORIF, while primary arthrodesis group including 35 cases. Outcome measures included radiographs, AOFAS scores, VAS and SF-36 scores. Complications and revision rate were analyzed also. Results: 73 patients were followed up for 21 months. At 1.5 years postoperatively, the AOFAS score was 75 and 83 in ORIF group and arthrodesis group. The VAS score was 3.0 and 2.1 separately in two groups. The mean Physical Functioning sores of SF- 36 was 81.2 points and 84.1 points. The Bodily Pain score of SF-36 was 79.3 points and 85.2 points. Redislocation of first tarsometarsal joint were observed in 11 cases among ORIF group.31 patients in ORIF group had pain in midfoot, six of them had persistent pain with the development of deformity or osteoarthrosis. No redislocation and no hardware failure was identified in arthrodesis group. Conclusion: Primary stable arthrodesis of the first ray gives a better short and medium term outcome than open reduction and internal fixation for Lisfranc injury with the first ray dislocation. Possible complication and revision could be avoided by primary arthrodesis for dislocated first ray injuries.

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Open Reduction and Internal Fixation to Repair a Lisfranc Injury: A Case Report

Annals of Clinical and Laboratory Research ◽

10.21767/2386-5180.100044 ◽

2015 ◽

Vol 3 (4) ◽

Author(s):

Nickul N Shah

Keyword(s):

Case Report ◽

Internal Fixation ◽

Open Reduction ◽

Lisfranc Injury

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Reoperation Rate Differences Between Open Reduction Internal Fixation and Primary Arthrodesis of Lisfranc Injuries

Foot & Ankle International ◽

10.1177/1071100718774005 ◽

2018 ◽

Vol 39 (9) ◽

pp. 1089-1096 ◽

Cited By ~ 11

Author(s):

Matteo Buda ◽

Shaun Kink ◽

Ruben Stavenuiter ◽

Catharina Noortje Hagemeijer ◽

Bonnie Chien ◽

...

Keyword(s):

Risk Factors ◽

Internal Fixation ◽

Open Reduction ◽

Open Reduction Internal Fixation ◽

Hardware Removal ◽

Patient Risk ◽

Operation Room ◽

Lisfranc Injuries ◽

Reoperation Rates

Background: Controversy persists as to whether Lisfranc injuries are best treated with open reduction internal fixation (ORIF) versus primary arthrodesis (PA). Reoperation rates certainly influence this debate, but prior studies are often confounded by inclusion of hardware removal as a complication rather than as a planned, staged procedure inherent to ORIF. The primary aim of this study was to evaluate whether reoperation rates, excluding planned hardware removal, differ between ORIF and PA. A secondary aim was to evaluate patient risk factors associated with reoperation after operative treatment of Lisfranc injuries. Methods: Between July 1991 and July 2016, adult patients who sustained closed, isolated Lisfranc injuries with or without fractures and who underwent ORIF or PA with a minimum follow-up of 12 months were analyzed. Reoperation rates for reasons other than planned hardware removal were examined, as were patient risk factors predictive of reoperation. Two hundred seventeen patients met enrollment criteria (mean follow-up, 62.5 ± 43.1 months; range, 12-184), of which 163 (75.1%) underwent ORIF and 54 (24.9%) underwent PA. Results: Overall and including planned procedures, patients treated with ORIF had a significantly higher rate of return to the operation room (75.5%) as compared to those in the PA group (31.5%, P < .001). When excluding planned hardware removal, however, there was no difference in reoperation rates between the 2 groups (29.5% in the ORIF group and 29.6% in the PA group, P = 1). Risk factors correlating with unplanned return to the operation room included deep infection ( P = .009-.001), delayed wound healing ( P = .008), and high-energy trauma ( P = .01). Conclusion: When excluding planned removal of hardware, patients with Lisfranc injuries treated with ORIF did not demonstrate a higher rate of reoperation compared with those undergoing PA. Level of Evidence: Level III, retrospective comparative study

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Lisfranc Injury - Surgical Fixation Facilities An Early Return To Work

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-87-116 ◽

2001 ◽

Vol 87 (2) ◽

pp. 116-119

Author(s):

M D Brinsden ◽

S R Smith ◽

P H Loxdale

Keyword(s):

Return To Work ◽

Internal Fixation ◽

Fracture Dislocation ◽

Lisfranc Injury ◽

Early Return ◽

Foot Injury ◽

Surgical Fixation ◽

One Year ◽

The Right ◽

Lisfranc Injuries

AbstractBackgroundLisfranc injury is rare and the diagnosis maybe easily missed. This study reviews the experience of a single centre.MethodsA prospective review of patients with Lisfranc injuries presenting to a single surgeon with a specialist interest in foot and ankle surgery over a one year period.ResultsFive patients were identified-four men and one woman with a median age of 31 years (range 22-50 years). Presentation was a mean of 25 days after injury (range 3-56 days). The left foot was affected in three cases and the right in two. There was joint diastasis in four patients and fracture-dislocation in one. Three patients presented early and were treated by internal fixation and two presented late and were managed conservatively. Mean follow-up was eight months (range 4.5-12 months). Surgery resulted in a return to work by 6 months with no symptoms. The two patients managed conservatively continued to experience pain at 12 months and were unable to return to their original occupations.ConclusionInjury to the Lisfranc joint should be excluded in any foot injury. Early diagnosis and internal fixation appears to result in an earlier return to work when compared to nonoperative management.

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Posttraumatic Pseudoarthrosis of a Clavicle Fracture in an 11-Year-Old Girl: A Case Report and Analysis

Case Reports in Orthopedics ◽

10.1155/2020/4069431 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Marco Odorizzi ◽

Maurice FitzGerald ◽

Jorge Gonzalez ◽

Dario Giunchi ◽

Flurim Hamitaga ◽

...

Keyword(s):

Case Report ◽

Conservative Treatment ◽

Internal Fixation ◽

Open Reduction ◽

Iliac Crest ◽

Clavicle Fracture ◽

Paediatric Population ◽

Iliac Crest Bone Graft ◽

The Right

Clavicular fractures are some of the most common bone injuries in the paediatric population, yet the rates of nonunion are very low under 18 years. To the best of our knowledge, posttraumatic nonunion of the clavicle in a paediatric population is rarely reported. We report the case of an 11-year-old girl who presented with a nondislocated fracture of the midshaft to the proximal third of the right clavicle. Initial conservative treatment by sling immobilization demonstrated radiologically confirmed healing at 3 months. However, at 1-year follow-up, she presented with painful nonunion. Diagnostic MRI and CT exams confirmed a pseudoarthrosis, requiring elective open reduction and internal fixation with the aid of an ipsilateral iliac crest bone graft.

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