Medial cuneiform to second metatarsal distance

Lisfranc injury fixation or arthrodesis typically involves the reduction and fixation of several tarsometatarsal joints with either screws or a plate and screw constructs. A successful fixation or arthrodesis of the Lisfranc joint requires proper screw placement from the medial cuneiform to the base of the second metatarsal. This is typically done free-hand; however, we describe use of an anterior cruciate ligament guide to help maintain reduction and assist with drill trajectory for more accurate screw or suture button construct placement. Levels of Evidence: Level V

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Screw in Lisfranc Ligament

Foot & Ankle Specialist ◽

10.1177/1938640020913447 ◽

2020 ◽

pp. 193864002091344

Author(s):

Stephen Sierra ◽

Vinod K. Panchbhavi

Keyword(s):

Case Reports ◽

Average Distance ◽

Healing Process ◽

Interosseous Ligament ◽

Screw Hole ◽

Attachment Sites ◽

Medial Cuneiform ◽

Second Metatarsal ◽

Relationship Of ◽

The Relationship

Background. Injury to the Lisfranc interosseous ligament is currently managed with a screw. However, this can potentially further disrupt the ligament. The objective of this study was to observe the proximity of the screw or disruption it can cause at the ligament attachment sites. Methods. Twenty-three feet were studied. A 40-mm, 4.0, partially threaded, cannulated screw was inserted from the base of the second metatarsal into the medial cuneiform. The relationship of the ligament attachment sites to the screw hole were measured. Results. The screw hole contacted at least 1 of the ligament attachment sites in 20 of the 23 feet. The screw hole fully penetrated it in 7 feet, partially disrupted it in 4 feet, and had less than or equal to 1 mm of contact in 9 feet. There was no contact with either of the attachment sites in 3 feet, with an average distance of 1.5 mm separating them. Conclusion. Our results show the proximity of the ligament to the screw and the disruption that can result from its insertion. This is clinically relevant as some amount ligamentous disruption is likely to occur with insertion of the “Lisfranc screw,” which may interfere with its healing process. Levels of Evidence: Level V: Expert opinion includes case reports and technique tips

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Ligamentous Lisfranc Joint Injuries: A Biomechanical Comparison of Dorsal Plate and Transarticular Screw Fixation

Foot & Ankle International ◽

10.1177/107110070502600607 ◽

2005 ◽

Vol 26 (6) ◽

pp. 462-473 ◽

Cited By ~ 117

Author(s):

Frank G. Alberta ◽

Michael S. Aronow ◽

Mauricio Barrero ◽

Vilmaris Diaz-Doran ◽

Raymond J. Sullivan ◽

...

Keyword(s):

Articular Surface ◽

Surface Damage ◽

Current Treatment ◽

Dorsal Plate ◽

Rigid Fixation ◽

First Metatarsal ◽

Medial Cuneiform ◽

Second Metatarsal ◽

Significant Difference ◽

Fresh Frozen

Background: The current treatment of displaced ligamentous injuries of the tarsometatarsal (TMT) joints is open reduction and rigid fixation using transarticular screws. This technique causes further articular surface damage that theoretically may increase the risk of arthritis. Should the screws break, hardware removal is difficult. An alternative method that avoids these potential complications is rigid fixation using dorsal plates. Methods: The displacement between the first metatarsal and medial cuneiform, the second metatarsal and intermediate cuneiform, the first and second metatarsal bases, and the medial cuneiform and second metatarsal base were measured in 10 matched pairs of fresh-frozen cadaver lower extremities in the unloaded and loaded condition. After sectioning the Lisfranc and TMT joint ligaments, measurements were repeated in the loaded condition. The first and second TMT joints of the right feet were fixed with transarticular 3.5-mm cortical screws while those of the left feet with were fixed with dorsal 2.7-mm 1/4 tubular plates. Measurements were then repeated in the unloaded and loaded condition. Results: After ligament sectioning, significantly increased first and second TMT joint subluxation with loading was seen. No significant difference was noted with direct comparison between plates and screws with respect to ability to realign the first and second TMT joints and to maintain TMT joint alignment during loading. The amount of articular surface destruction caused by one 3.5-mm screw was 2.0 ± 0.7% for the medial cuneiform, 2.6 ± 0.5% for the first metatarsal, 3.6 ± 1.2% for the intermediate cuneiform, and 3.6 ± 1.0% for the second metatarsal. Conclusions: The model reliably produced displacement of the first and second TMT joints consistent with a ligamentous Lisfranc injury. Transarticular screws and dorsal plates showed similar ability to reduce the first and second TMT joints after TMT and Lisfranc ligament transection and to resist TMT joint displacement with weightbearing load. Clinical relevance: Dorsal plating may be an alternative to transarticular screws in the treatment of displaced Lisfranc injuries.

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Plantar Lateral Dislocation of the Medial Cuneiform: A Case Report

Foot & Ankle International ◽

10.1177/107110079801900213 ◽

1998 ◽

Vol 19 (2) ◽

pp. 118-119 ◽

Cited By ~ 14

Author(s):

Benjamin P. Levine ◽

Robert Stoppacher ◽

Thomas K. Kristiansen

Keyword(s):

Case Report ◽

Similar Case ◽

Avulsion Fracture ◽

Delayed Diagnosis ◽

Lateral Dislocation ◽

Medial Cuneiform ◽

Second Metatarsal ◽

Anterior Tibialis ◽

Current Report

This case report describes an isolated plantar lateral dislocation of the medial cuneiform. We were able to find only one other similar case reported in the literature. That case had a delayed diagnosis of 5 months and with an associated an avulsion fracture of the second metatarsal base. 4 Dines et al. 3 reported an isolated dorsomedial dislocation at the medial cuneonavicular joint. An irreducible dorsomedial dislocation with the anterior tibialis tendon being trapped between the medial cuneiform and the navicular has been reported. 2 A distal and lateral dislocation of the medial cuneiform was reported in association with displacement of the second to fourth metatarsal and medial fractures of the navicular and cuneiform. 1 The current report differs from previous cases. There was not an associated fracture; the direction of the dislocation was unique and could be reduced closed.

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Nonunion of a Stress Fracture at the Base of the Second Metatarsal in a Soccer Player Treated by Osteosynthesis with the Bridging Plate Fixation Technique

Case Reports in Orthopedics ◽

10.1155/2020/6649443 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Futoshi Morio ◽

Shota Morimoto ◽

Shintaro Onishi ◽

Toshiya Tachibana ◽

Tomoya Iseki

Keyword(s):

Conservative Treatment ◽

Stress Fracture ◽

Soccer Player ◽

Plate Fixation ◽

Radiographic Examination ◽

Fixation Technique ◽

Initial Surgery ◽

Medial Cuneiform ◽

Second Metatarsal ◽

Female Soccer Player

Background. A stress fracture of the second metatarsal base in soccer players is extremely rare. In this case study, we report a nonunion of a stress fracture at the base of the second metatarsal in a female soccer player who had persistent pain despite continued conservative treatment, who then was treated with the bridging plate fixation technique. Case Report. A 19-year-old female college soccer player complained of pain on the dorsum of her right midfoot during a game without history of trauma and was conservatively treated for 6 months. Radiographic examination showed an oblique fracture with small bone fragment at the proximal base of the second metatarsal and computed tomography demonstrated sclerotic change around the fracture site. We diagnosed her with nonunion of a stress fracture at the base of the second metatarsal and performed operative treatments using autogenous cancellous iliac bone grafting and plate fixation bridging a second metatarsal and medial cuneiform with a locking plate. At 4 months after the initial surgery, she was able to return to playing soccer at preinjury level without complications or pain. Conclusion. We report a rare case of nonunion of a stress fracture at the base of the second metatarsal in a female soccer player without underlying diseases. Surgical treatment was applied, because the conservative treatment was ineffective for 6 months and led to nonunion. The plate fixation technique bridging the second metatarsal and medial cuneiform was a useful option to attain the bone fusion for small fracture fragment for a treatment of nonunion of a stress fracture at the base of the second metatarsal.

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Screw in Lisfranc Ligament

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000313 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Vinod Panchbhavi ◽

Stephen Sierra

Keyword(s):

Guide Wire ◽

Average Distance ◽

Current Treatment ◽

Rigid Fixation ◽

Transarticular Screw ◽

Interosseous Ligament ◽

Medial Cuneiform ◽

Second Metatarsal ◽

Lisfranc Ligament ◽

Minimal Contact

Category: Trauma Introduction/Purpose: The Lisfranc ligament is an interosseous ligament connecting the medial cuneiform with the second metatarsal. Current treatment of displaced Lisfranc injury is rigid fixation using a transarticular screw. The purpose of this study was to observe the amount of ligamentous disruption with the placement of a transarticular screw from the second metatarsal to the medial cuneiform. Methods: This cadaveric study included a total of 15 preserved cadavers and 23 feet. Blunt dissection down to bone, with removal of soft tissue, was performed on each foot for visualization of the Lisfranc joint. A guide-wire was inserted in a dorsolateral to plantar medial direction from the base of the second metatarsal into the medial cuneiform. Then over the guide- wire a 40 mm, 4.0 partially threaded, cannulated screw was inserted. The Lisfranc ligament was then carefully identified with more dissection. The screw was then removed. Separation of the second metatarsal from medial cuneiform was performed by transecting the dorsal, Lisfranc (interosseous), and plantar ligaments. Digital photographs of the Lisfranc ligament, medial cuneiform and second metatarsal articular surfaces were recorded and measurements were taken. Results: Of the 23 feet, the screw came in contact with the Lifranc ligament in 20 feet. The screw fully penetrated the ligament in 7 feet, partially disrupted it in 4 feet, and had <1 mm of contact in 9 feet. In 3 feet, there was no contact with the ligament with an average distance of 1.5 mm. Conclusion: Our results reveal the amount of disruption a transarticular screw, placed in a dorsolateral to plantar medial direction, will have on the Lisfranc ligament. Although the screw came into contact with the ligament in 20 out of 23 feet, only 13 feet had partial disruption or minimal contact and 3 feet had no contact at all. This is clinically relevant because ligamentous damage due to insertion and/or presence of screw in anatomic location of the ligament may interfere with its healing.

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In Vitro Determination of Midfoot Motion

Foot & Ankle ◽

10.1177/107110078901000305 ◽

1989 ◽

Vol 10 (3) ◽

pp. 140-146 ◽

Cited By ~ 162

Author(s):

Tye J. Ouzounian ◽

Michael J. Shereff

Keyword(s):

Dimensional Space ◽

Plantar Flexion ◽

Three Dimensional ◽

First Metatarsal ◽

Below The Knee ◽

Medial Cuneiform ◽

Second Metatarsal ◽

Fresh Frozen ◽

Vitro Model

Midfoot motion was determined using an in vitro model. Ten fresh-frozen below-the-knee amputation specimens were instrumented by inserting reference pins into each of the bones of the hindfoot, midfoot and metatarsals. Dorsiflexion-plantar flexion and supination-pronation were simulated and the reference pin location in three dimensional space was determined. Comparing the location of the reference pins at each simulated position, motion was determined. Motion occurring through each articulation (dorsiflexion-plantar flexion/supination-pronation) in degrees was: talonavicular (7.0/17.7), calcaneocuboid (2.3/ 7.3), naviculo-medial cuneiform (5.0/7.3), naviculo-middle cuneiform (5.2/3.5), naviculo-lateral cuneiform (2.6/2.1), medial cuneiform-first metatarsal (3.5/1.5), middle cuneiform-second metatarsal (0.6/1.2), lateral cuneiform-third metatarsal (1.6/2.6), cuboid-fourth metatarsal (9.6/11.1), and cuboid-fifth metatarsal (10.2/9.0).

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Articulating Os Intermetatarsium with painful ganglion cyst

Medical Science and Discovery ◽

10.36472/msd.v8i5.546 ◽

2021 ◽

Vol 8 (5) ◽

pp. 341-344

Author(s):

Celestie Yaacoub ◽

Ahmad Kanj ◽

Malak Eljebai ◽

Georges Rouhana ◽

Ali Kanj

Keyword(s):

Ganglion Cyst ◽

Foot Pain ◽

Foot And Ankle ◽

Medial Cuneiform ◽

Second Metatarsal

Objective: Sesamoid and accessory bones are commonly found in the foot and ankle with varying incidence. The Os intermetatarsium, located between the medial cuneiform and the base of the first and second metatarsal, occurs rarely and is frequently asymptomatic. Few symptomatic cases of this condition are reported in the literature. The development of synovial ganglion cyst over an os intermetatarsium is a more occasional finding not clearly reported in the literature. Case: Here we report the case of a 22 year old female presenting with pain and localized swelling in the dorsum of the midfoot who was found to have a ganglion cyst emerging from an articulating os intermetatarsium. Conclusion: Although not a common entity, an Os intermetarsium, with its associated complications, can be one of the causes of dorsal foot pain.

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Biomechanical Comparison of FiberTape Device Repair Techniques of Ligamentous Lisfranc Injury in Cadaveric Model

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00050 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0005

Author(s):

Zachary Koroneos ◽

Emily Vannatta ◽

Morgan S. Kim ◽

Madelaine W. Fritsche ◽

Trevin Cowman ◽

...

Keyword(s):

Cyclic Loading ◽

Screw Fixation ◽

Angular Displacement ◽

Reaction Force ◽

Interference Screw ◽

Fixation Method ◽

Medial Cuneiform ◽

Second Metatarsal ◽

Interference Screw Fixation ◽

Cadaveric Model

Category: Trauma; Basic Sciences/Biologics; Midfoot/Forefoot; Sports Introduction/Purpose: Lisfranc ligamentous injuries are complex. Controversy exists regarding their treatment and preferred method of fixation. Fixation methods employing a FiberTape device and interference screw fixation have been described as an alternative to traditional screw fixation. The purpose of this biomechanical study was to evaluate two methods of fixation utilizing interference screw fixation with FiberTape augmentation in a cadaveric model. Methods: 9 paired cadaveric feet (mid tibia/fibula) were separated into two groups based on fixation method: FiberTape alone and FiberTape with supplementary limb into the middle cuneiform via anchor. At three joints of the midfoot (second metatarsal - medial cuneiform, intermediate cuneiform - medial cuneiform, second metatarsal - intermediate cuneiform), the diastasis and relative angular displacement between bones in the coronal plane were measured for static and cyclic loading. Measurements were obtained for the native (pre-injured), injured, and post-fixation in static loading. Fixed specimens then underwent stepwise increases in cyclic loading performed at 1 Hz and 100 cycles, at 100 N intervals from 500 to 1800 N ground reaction force. The Achilles tendon was also loaded to simulate postoperative weightbearing. Failure of fixation was defined as diastasis at the second metatarsal - medial cuneiform joint greater than 2 millimeters. Results: FiberTape specimens demonstrated diastasis failures of 3 of 9 (33%) specimens at cyclic loads of 1000 N. Conversely, FiberTape with supplementary limb specimens all survived past this loading magnitude, with 1 failing at supraphysiologic loads (>1200 N). The difference in diastasis at the second metatarsal-medial cuneiform joint was statistically significant between the two groups at forces of 1600N (p = 0.019) and 1800N (p = 0.029). There were no significant differences between the other joint diastases and relative angular displacements. Conclusion: The use of FiberTape for fixation of ligamentous Lisfranc injuries appears to provide a biomechanically viable alternative for withstanding early post-operative protected weightbearing. Furthermore, the use of a supplementary limb in addition to the FiberTape fixation method appears to enhance its biomechanical efficacy under cyclic loading especially at higher loads.

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