Clinical Study on Different Methods of Internal Fixation for Treatment of Lisfranc Joint Injury

The Lisfranc joints are mainly used to connect the forefoot and midfoot and maintain the stability of the arch of the foot. It is an important part of the arch of the foot. If the Lisfranc joints injury is not treated in time, it will cause poor walking, pain in the back of the foot, and even deformity or disability of the forefoot. The common treatment method is to select the Kirschner wires, screws, or steel plates for incisional repositioning internal fixation surgery. In our study, we used different materials to perform fixation surgery on Lisfranc joint injury patients. We measured the joint recovery, pain condition, complications, and biomechanical indexes of different groups of patients after the operation. The results of the study showed that compared with Kirschner wire and screw internal fixation, the use of shaped arch bridge-type microsteel plate internal fixation for the treatment of metatarsotarsal joint injury patients has better foot function recovery, fewer complications, and more reliable biomechanical strength.

Dislocation of the first metatarsophalangeal joint concomitant with Lisfranc joint dislocation in a 45-year-old man

A 45-year-old man presented with severe pinch-point crush injury to his left foot. Plain radiographs revealed dislocation of the first metatarsophalangeal joint and dorsolateral dislocation of the basal phalanx and sesamoids. The first tarsometatarsal joint was subluxed in the plantar direction and the second to fourth tarsometatarsal joints were subluxed dorsally. The sesamoids were displaced dorsolateral to the metatarsal head. There was a longitudinal tear of the joint capsule at the medial margin of the medial sesamoid, which was sutured together with the abductor hallucis tendon and collateral ligament. The Lisfranc and dorsal ligaments in the tarsometatarsal joint were torn and repaired after reduction and fixed with a plate. One year after surgery, there was contracture of the first metatarsophalangeal joint, but the patient had no pain and was able to run.

Using Area and Volume Measurements on Weightbearing CT to Detect Isolated Lisfranc Instability

Category: Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Early detection of Lisfranc instability is critical for optimizing clinical outcomes. Injuries causing a more subtle instability, however, can be difficult to diagnose. The aim of this study was to compare the injured Lisfranc joint to the healthy contralateral side using weightbearing computed tomography (CT) in patients with known Lisfranc instability. We also aimed to define the range of normal measurement variation by comparing the Lisfranc joint measurements between the left and right foot in individuals without foot injury who underwent similar imaging. Our hypothesis was that compared to the healthy contralateral side, weightbearing CT area and volume measurements were increased in patients diagnosed with subtle Lisfranc instability. Methods: Patients with unilateral Lisfranc instability requiring operative fixation (n = 14) underwent preoperative bilateral foot and ankle weightbearing CT. A separate group of patients without foot injury who also underwent similar imaging were included as comparative controls (n = 36). For each weightbearing CT, 2 dimensional axial and coronal plane Lisfranc joint parameters, Lisfranc area, intercuneiform area, C1-M2 distance, C1-C2 distance, M1-M2 distance, first and second tarsometatarsal (TMT 1 and 2) alignment; and first and second tarsometatarsal (TMT 1and 2) dorsal step off were measured to evaluate the Lisfranc anatomy at a level 10 mm below the dorsal surface of medial cuneiform (Figures I and II). In addition, the volume of the Lisfranc joint was also evaluated. Values were recorded by two independent observers to assess interobserver reliability. Results: Among those with unilateral Lisfranc instability, values differed largely between the injured and the healthy contralateral side for all measurements performed (p-value range, 0.008 - <0.001). In the control population without foot injury, no differences were identified between any of the bilateral measurements (p-value range, 0.121 - 0.984). Conclusion: Weightbearing CT can effectively differentiate Lisfranc instability from those without instability. The Lisfranc volume and area had the largest difference between the injured and the uninjured feet among surgically treated patients with substantial interrater agreement making them the most relevant parameters for detecting Lisfranc instability. However, prospective studies are needed to validate the role of weightbearing CT in the diagnosis of subtle Lisfranc instability.

Comparative Assessment of Midfoot Osteoarthritis Diagnostic Sensitivity Using Weightbearing Computed Tomography vs Weightbearing Radiography

Category: Midfoot/Forefoot; Other Introduction/Purpose: Osteoarthritis (OA) of the midfoot can elicit significant pain, disability, and decreased quality of life in affected patients. Therefore, correct diagnosis and appropriate, timely interventions towards this degeneration is essential. Currently, weightbearing radiography (WBR) has been widely accepted as the standard method in assessing midfoot OA. However, the complex structural anatomy of this region poses unique challenges in its visualization due to the obscurance caused by the overlapping osseous structures present when observed in a two-dimensional perspective. Weightbearing computed tomography (WBCT), providing a relatively clearer visualization of the midfoot could also be used for evaluation. This study aims to perform a single center, retrospective, intra-patient analysis identifying the discrepancy in midfoot OA diagnostic sensitivity among the two imaging modalities (WBCT vs. WBR). Methods: After gaining approval from an internal review board, a retrospective analysis of patient electronic health records was performed to assess the discrepancy of midfoot OA diagnostic sensitivity among WBCT and WBR. The radiological interpretation (RI) of 761 consecutive patient WBCT images were systematically assessed for OA diagnosed in 3 midfoot joint groups (Chopart group; 2 joints, midfoot group; 6 joints, Lisfranc group; 5 joints). A case was considered positive for OA if the WBCT RI contained any explicit mention of midfoot OA or any reported signs of the pathology including mild, moderate, or severe degeneration, joint space narrowing, osteophytic changes, spurring, cystic changes, or sclerosis in at least one of the aforementioned joint groups. After an appropriate washout period, the observer then synonymously reviewed the WBR RI of each positive OA case. A sensitivity metric was calculated for the OA incidence and severity discrepancy between the two imaging modalities. Results: A total of 302 (mean age, 56.0 +- 16.0 years; 140 left and 162 right) feet were assessed in this study. 244 cases of Chopart OA were detected on WBCT RI, where only 184 cases were detected on the WBR RI of the same feet, resulting in a diagnostic discrepancy of 24.6%. In the midfoot joint group, WBCT RI and WBR RI detected 96 and 67 cases of OA respectively, yielding a 30.2% discrepancy. Finally, in the Lisfranc joint group, the WBCT and WBR RI detected 174 and 129 cases of OA, respectively, showing a 25.9% discrepancy in diagnosis. Additionally, the OA severity was downgraded between modalities in 7.0%, 4.2%, and 8.0% for the Chopart, midfoot, and Lisfranc joint groups, respectively. Conclusion: After assessing 244 Chopart, 96 midfoot, and 174 Lisfranc cases of OA detected by WBCT, a significant discrepancy has been observed in the diagnostic abilities of midfoot OA among the two imaging modalities studied. With this difference realized, in addition to the recent higher availability, decreasing cost, and low radiation exposure offered by WBCT, this imaging modality may have the ability to aid physicians considerably in their clinical practice. Detecting and correctly diagnosing the severity of this pathology may lead to more appropriate treatment options, lower complication rates, and better patient outcomes.