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

Alberta, Frank G.; Aronow, Michael S.; Barrero, Mauricio; Diaz-Doran, Vilmaris; Sullivan, Raymond J.; Adams, Douglas

doi:10.1177/107110070502600607

Cited by 185 publications

(147 citation statements)

References 31 publications

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“…An early intervention appears to be more advantageous for a good outcome than a late surgical correction [9,10,16]. Thorough analysis of the outcome after anatomical reduction and temporary Lisfranc joint transfixation compared with a primary arthrodesis, which is often recommended in the USA following exclusively ligamentous Lisfranc injuries [6,14,17,22,24], does not necessarily speak in favor of a primary arthrodesis instead of a joint preservation [16,25]. A homogeneous case series of a single surgeon did not show any inferior prognosis in purely ligamentous Lisfranc joint lesions, but only in high-energy crush injuries [26].…”

Section: Resultsmentioning

confidence: 99%

Reconstruction After Malunited Lisfranc Injuries

2010

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Symptomatic secondary osteoarthritis of the Lisfranc joints due to malunion following Lisfranc joint fracture dislocations or ligamentous lesions at the Lisfranc and innominate joint level generally lead to a painful functional loss and a substantial disturbance of the walking performance. Initially missed or inadequately addressed primary lesions still represent the major source of Lisfranc joint malunions. Neuro-osteoarthropathic disorders may also become manifest in the Lisfranc joint region and may be mistaken for truly posttraumatic consequences. Secondary osteoarthritis may be combined with typical multiplanar deformities. The concept of a corrective arthrodesis includes restoration of stable physiologic axes and length proportions of the foot columns. A standardized approach to analyze the clinical picture and corresponding pathomorphology and the transfer into a comprehensive surgical concept which respects the realignment of any component of deformity is a prerequisite for a good functional outcome and a high degree of patient satisfaction. A fusion limited to the medial three rays combined with a soft tissue release may be sufficient for a favorable outcome in the majority of cases and preserve the mobility of the two lateral rays.

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Section: Resultsmentioning

confidence: 99%

Reconstruction After Malunited Lisfranc Injuries

2010

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“…Stabilization with Kirshner's wires, despite being easier, does not provide proper compression, and the use of plates and screws has as a disadvantage a high degree of surgical aggression, and, in some patients, postoperative discomfort, sometimes requiring removal of the synthesis material after procedure consolidation (8,11) . Today, the method of choice for most authors is the cortical screw, which, when percutaneously introduced, assure an excellent stability and compression, with restricted surgical aggression.…”

Section: Discussionmentioning

confidence: 99%

“…Cortical Screws provide a stable fixation with significant compression, from the joint, but require a difficult implantation technique, which enables a small error margin (10,11) . Dorsal plates and screws are stable, rigid fixation devices that provide compression, require a considerable manipulation of soft tissues to be implanted and frequently require the removal of the synthesis material at postoperative follow-up period (11) .…”

Section: Introductionmentioning

confidence: 99%

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Estabilização da artrodese da articulação tarsometatársica: estudo biomecânico

et al. 2008

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INTRODUÇAO: As artrodeses tarsometatársicas sao opçao terapeutica efetiva no tratamento das osteoartroses sintomaticas da articulacao de Lisfranc. Os métodos de estabilizaçao disponíveis sao: Fios de Kirschner, Parafusos Corticais, Placas e parafusos e Agrafe. A estabilidade oferecida e a técnica cirúrgica utilizada para cada material é discutida na literatura. OBJETIVO: Comparar a força de compressão e a estabilidade biomecânica da fixação da articulação tarsometatársica com Parafusos Corticais e com Agrafe. CASUISTICA E MÉTODO: Selecionados 10 cadáveres frescos, do genero masculino, idade variando de 35 a 49 anos, foram submetidas a dissecçao do cúboide e do 4° metatarso bilateralmente, decorticadas as superfícies articulares e realizada fixação com parafuso cortical - Cortical Screw 3.5mm Impol, e Agrafe - Uni-clip® Staple 2.0 NewDeal. RESULTADOS: Os 20 ensaios biomecânicos foram completados. A analise estatística dos métodos agrafe vs parafuso cortical, em relação a energia acumulada até atingir o pico de força do ensaio p= 0.047, e a energia acumulada até o final do ensaio p= 0.047 apresentaram diferença significativa. CONCLUSÃO: Os picos de carga suportados pelas estabilizaçoes com agrafe e com parafuso cortical decrescem, significativamente, com a idade. Observa-se valores de força superiores para o agrafe em ossos osteoporóticos. A energia acumulada na area de trabalho dos graficos nos ensaios com o agrafe, mostram-se estatisticamente superiores aos valores para os Parafusos Corticais.

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“…Most surgeons recommend screw or plate fixation for a fresh unstable subtle injury [1,2,[7][8][9], and novel techniques using Endobutton [10] or Tightrope [11] have been recently reported. Although good clinical outcomes have been reported after operations [1,2,[7][8][9][10][11], a standard operative technique does not exist for chronic symptomatic cases that failed to respond to conservative treatment or did not undergo appropriate initial treatment because of misdiagnosis as a simple midfoot sprain. We therefore developed a novel technique for Lisfranc ligaments reconstruction using autologous gracilis tendon to treat chronic subtle injury.…”

Section: Introductionmentioning

confidence: 99%