Determining the Strongest Orientation for “Lisfranc's Screw” in Transverse Plane Tarsometatarsal Injuries: A Cadaveric Study

Cook, Keith D.; Jeffries, Luke C.; O’Connor, J. P.; Svach, David J.

doi:10.1053/j.jfas.2009.02.009

Cited by 15 publications

(6 citation statements)

References 6 publications

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“…The second TMT and Lisfranc instability was stabilized with screw fixation from the medial cuneiform to second MT in a diagonal path (“home run screw”). 5 Medial column (ie, MCD) fixation used the same medial cuneiform to second MT approach in addition to 1 to 2 transverse screw fixation from the medial cuneiform to the middle cuneiform. Lastly, during proximal extension repairs, the senior author stabilized the first and second TMT joints using the same technique as the traditional pattern (screw or plate fixation for first TMT and diagonal screw fixation from the medial cuneiform to second MT), and either 1 or 2 screws across the intercuneiform (MeC to MiC) joint.…”

Section: Methodsmentioning

confidence: 99%

Injury Pattern in Ligamentous Lisfranc Injuries in Competitive Athletes

et al. 2018

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Background: We report data on the largest cohort to date of patients who sustained a ligamentous Lisfranc injury during sport. To date, the prevalence of concurrent intercuneiform ligament injuries in the competitive athlete with subtle Lisfranc instability has not been reported. Methods: Eighty-two patients (64 males, 18 females) sustained an unstable Lisfranc injury (49 left, 33 right) and met inclusion criteria. Injuries were classified as traditional dislocation (TRAD, first to second TMT ligament tear), medial column dislocation (MCD, second TMT, and medial-middle cuneiform ligament tear), or proximal extension dislocation (PE, first, second, and medial-middle cuneiform ligament tear) and the injury pattern confirmed at surgery. All athletes underwent open reduction with internal fixation (ORIF) of each unstable midfoot segment. Fisher exact tests and 2-tailed t tests were used to analyze statistical significance according to injury pattern, sport, gender difference, hindfoot angle alignment, and injured side ( P < .05). Results: Average age of athletes was 21.0 ± 5.3 years old (range 12-40), and return to sports was 7.5 ± 2.1 months. Injury distribution was as follows: TRAD (n = 40), MCD (n = 17), and PE (n = 23). MCD trended toward a longer return to sport (8.4 ± 3.3 months, P = .074). Football was the most common sport at time of injury (n = 48). Wakeboard athletes (n = 5) were older (31.4 ± 3.2, P = .0002), and MCD tears were more prevalent among them ( P = .061). Basketball (n = 13) players were significantly younger (19.1 ± 2.5 years, P = .028) and returned to sports quicker (5.2 ± 0.7, P = .0002). Return to sport data indicated a typical population for athletes with Lisfranc injury in these sports. Conclusion: Proximal extension disruption (intercuneiform ligament tear) occurred in 50% of these low-energy Lisfranc athletic injuries. MCD and PE may be more prevalent than previously understood. This is the first study to document the extent, pattern, and prevalence of associated intercuneiform ligament tears in the competitive athlete with a low-energy subtle, unstable Lisfranc injury. Level of Evidence: Level IV, retrospective case series.

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Section: Methodsmentioning

confidence: 99%

Injury Pattern in Ligamentous Lisfranc Injuries in Competitive Athletes

et al. 2018

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“…The second tarsometatarsal joint was reduced first. Generally, once the base of the second metatarsal had been reduced anatomically, the first metatarsal was positioned correctly on the medial cuneiform [12, 13]. The remaining tarsometatarsal joints were then easily reduced.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of computed tomography post-processing images in postoperative assessment of Lisfranc injuries compared with plain radiographs

Chen

Qiang

et al. 2017

J Orthop Surg Res

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BackgroundThe objective of this study is to evaluate the value of computed tomography (CT) post-processing images in postoperative assessment of Lisfranc injuries compared with plain radiographs.MethodsA total of 79 cases with closed Lisfranc injuries that were treated with conventional open reduction and internal fixation from January 2010 to June 2016 were analyzed. Postoperative assessment was performed by two independent orthopedic surgeons with both plain radiographs and CT post-processing images. Inter- and intra-observer agreement were analyzed by kappa statistics while the differences between the two postoperative imaging assessments were assessed using the χ 2 test (McNemar’s test). Significance was assumed when p < 0.05.ResultsInter- and intra-observer agreement of CT post-processing images was much higher than that of plain radiographs. Non-anatomic reduction was more easily identified in patients with injuries of Myerson classifications A, B1, B2, and C1 using CT post-processing images with overall groups (p < 0.05), and poor internal fixation was also more easily detected in patients with injuries of Myerson classifications A, B1, B2, and C2 using CT post-processing images with overall groups (p < 0.05).ConclusionsCT post-processing images can be more reliable than plain radiographs in the postoperative assessment of reduction and implant placement for Lisfranc injuries.

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“…Most cadaveric biomechanical studies use axial loading and have limited joint damage; therefore, relatively small intra-articular Lisfranc displacements are achieved, which makes it difficult to correlate the results to clinical scenarios. 4,6 It is important to note that fixation stability, after all, is most important only while healing is occurring.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Suture-Augmented Ligamentplasty to Transarticular Screws in a Lisfranc Cadaveric Model

Nery

Baumfeld

et al. 2020

Foot Ankle Int.

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Background: Lisfranc injuries represent a spectrum of trauma from high-energy lesions, with significant instability of the midfoot, to low-energy lesions, with subtle subluxations or instability without gross displacement. Recently, treatment options that allow for physiologic fixation of this multiplanar joint are being evaluated. The purpose of this study was to analyze the stability of a cadaveric Lisfranc injury model fixed with a novel suture-augmented neoligamentplasty in comparison with a traditional transarticular screw fixation construct. Methods: Twenty-four fresh-frozen, matched cadaveric leg and foot specimens (12 individuals younger than 65 years of age) were used for this study. Two different types of Lisfranc ligament injuries were tested: partial and complete. Two different methods of fixation were compared: transarticular screws and augmented suture ligamentplasty with FiberTape. Specimens were fixed to a rotation platform in order to stress the joints while applying 400 N of axial load and internal and external rotation. Six distances were measured and compared between the intact, injured, and fixed states with a 3D Digitizer arm, in order to evaluate the stability between them. Analysis of variance was used with P < .05 considered significant. Results: Using distribution graphs and analyzing the grouped data, it was observed that there was no difference between the 2 stabilization methods, but the augmented suture ligamentplasty presented lower variability and observed distance shortenings were more likely to be around the mean. The variability of the stabilization with screws was 2.9 times higher than that with tape ( P < .001). Conclusion: We suggest that augmented suture ligamentplasty can achieve similar stability to classic transarticular screws, with less variability. Clinical Relevance: This cadaveric study adds new information on the debate about Lisfranc lesions treatment. Flexible fixations, such as the synthethic ligamentplasty used, can restore good stability such as conventional transarticular screws.

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Determining the Strongest Orientation for “Lisfranc's Screw” in Transverse Plane Tarsometatarsal Injuries: A Cadaveric Study

Cited by 15 publications

References 6 publications

Injury Pattern in Ligamentous Lisfranc Injuries in Competitive Athletes

Injury Pattern in Ligamentous Lisfranc Injuries in Competitive Athletes

Evaluation of computed tomography post-processing images in postoperative assessment of Lisfranc injuries compared with plain radiographs

Comparison of Suture-Augmented Ligamentplasty to Transarticular Screws in a Lisfranc Cadaveric Model

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