Injury Characteristics of Low-Energy Lisfranc Injuries Compared With High-Energy Injuries

Renninger, Christopher; Cochran, Grant; Tompane, Trevor; Bellamy, Joseph; Kuhn, Kevin

doi:10.1177/1071100717709575

Cited by 43 publications

(34 citation statements)

References 26 publications

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“…Low-energy injuries are known to have better results than the high-energy injuries in terms of outcome scores, postoperative reduction, and post-traumatic osteoarthritis. 17 , 27 , 34 Only the patients with clinically and/or radiologically suspected nonunion were evaluated with CT scans. We thereby might have missed nonunions with only minor symptoms.…”

Section: Discussionmentioning

confidence: 99%

Temporary Bridge Plating vs Primary Arthrodesis of the First Tarsometatarsal Joint in Lisfranc Injuries: Randomized Controlled Trial

et al. 2020

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Background: Unstable Lisfranc injuries are best treated with anatomic reduction and stable fixation. There are controversies regarding which type of stabilization is best. In the present study, we compared primary arthrodesis of the first tarsometatarsal (TMT) joint to temporary bridge plating in unstable Lisfranc injuries. Methods: Forty-eight patients with Lisfranc injuries were included and followed for 2 years. Twenty-four patients were randomized to primary arthrodesis (PA) of the medial 3 TMT joints, whereas 24 patients were randomized to temporary bridge plate (BP) over the first TMT joint and primary arthrodesis of the second and third TMT joints. The main outcome parameter was the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scale and the secondary outcome parameters were the 36-Item Short Form Health Survey (SF-36) and visual analog scale for pain (VAS pain). Computed tomography (CT) scans pre- and postoperatively were obtained. Radiographs were obtained at follow-ups. Pedobarographic examination was performed at the 2-year follow-up. Twenty-two of 24 patients in the PA and 23/24 in the BP group completed the 2-year follow-up. Results: The mean AOFAS midfoot score 2 years postoperatively was 89 (SD 9) in the PA group and 85 (SD 15) in the BP group ( P = .32). There were no significant differences between the groups with regard to SF-36 or VAS pain scores. The alignment of the first metatarsal was better in the BP group than in the PA group measured by the anteroposterior Meary angle ( P = .04). The PA group had a reduced peak pressure under the fifth metatarsal ( P = .047). In the BP group, 11/24 patients had radiologic signs of osteoarthritis in the first TMT joint. Conclusion: Both treatment groups had good outcome scores. The first metatarsal was better aligned in the BP group; however, there was a high incidence of radiographic osteoarthritis in this group. Level of Evidence: Therapeutic level I, prospective randomized controlled study.

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Section: Discussionmentioning

confidence: 99%

Temporary Bridge Plating vs Primary Arthrodesis of the First Tarsometatarsal Joint in Lisfranc Injuries: Randomized Controlled Trial

et al. 2020

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“…The strength of our study was the large data sample that included a broad range of Lisfranc injuries. Since the term 'Lisfranc injury' is indicative of a wide variety of different injuries in terms of severity, displacement and number of affected joints, it is essential to evaluate the diagnostics with an appropriate study sample [18,30,33,43]. The limitation of our study was that the radiographs were only evaluated by orthopaedic surgeons and orthopaedic surgery residents who are familiar with Lisfranc injuries.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, multiple classifications have been presented, yet there is still no consensus on the precise definition of Lisfranc injuries [6,25,33]. Nevertheless, Lisfranc injury is recognized nowadays as a wide variety of both bony and ligamentous injuries of the TMT joint region ranging from subtle ligamentous injuries to severely displaced or crush injuries [21,25,33,35,43,45].…”

Section: Introductionmentioning

confidence: 99%

Inter- and intraobserver reliability of non-weight-bearing foot radiographs compared with CT in Lisfranc injuries

Ponkilainen

Partio

Salonen

et al. 2020

Arch Orthop Trauma Surg

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Background Injury of the tarsometatarsal (TMT) joint complex, known as Lisfranc injury, covers a wide range of injuries from subtle ligamentous injuries to severely displaced crush injuries. Although it is known that these injuries are commonly missed, the literature on the accuracy of the diagnostics is limited. The diagnostic accuracy of non-weight-bearing radiography (inter-or intraobserver reliability), however, has not previously been assessed among patients with Lisfranc injury. Methods One hundred sets of foot radiographs acquired due to acute foot injury were collected and anonymised. The diagnosis of these patients was confirmed with a CT scan. In one-third of the radiographs, there was no Lisfranc injury; in onethird, a nondisplaced (< 2 mm) injury; and in one-third, a displaced injury. The radiographs were assessed independently by three senior orthopaedic surgeons and three orthopaedic surgery residents. Results Fleiss kappa (κ) coefficient for interobserver reliability resulted in moderate correlation κ = 0.50 (95% CI: 0.45-0.55) (first evaluation) and κ = 0.58 (95% CI: 0.52-0.63) (second evaluation). After three months, the evaluation was repeated and the Cohen's kappa (κ) coefficient for intraobserver reliability showed substantial correlation κ = 0.71 (from 0.64 to 0.85). The mean (range) sensitivity was 76.1% (60.6-92.4) and specificity was 85.3% (52.9-100). The sensitivity of subtle injuries was lower than severe injuries (65.4% vs 87.1% p = 0.003). Conclusions Diagnosis of Lisfranc injury based on non-weight-bearing radiographs has moderate agreement between observers and substantial agreement between the same observer in different moments. A substantial number (24%) of injuries are missed if only non-weight-bearing radiographs are used. Nondisplaced injuries were more commonly missed than displaced injuries, and therefore, special caution should be used when the clinical signs are subtle. Level of evidence III.

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“…2,10 Some authors classify these injuries as "high-energy" and "low-energy" based on the trauma mechanism. 19,21,23 Renninger et al 21 studied the differences between low-and high-energy injuries. Low-energy injuries included athletic activity, ground-level twisting, and fall from less than 4 feet.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Characteristics of Midfoot Injuries

et al. 2018

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Lisfranc injury was originally described as a partial or complete dislocation of the tarsometatarsal (TMT) joints by Quenu and Kuss in 1909. 18 Nunley and Vertullo 16 described that the injury can also be subtle when there is no detectable dislocation in nonweightbearing radiographs. Recently, however, Chiodo and Myerson 2 introduced a new approach to these injuries where they suggested to divide the injuries in medial (TMT 1), central (TMT 2-3), and lateral (TMT 4-5) columns. Lau et al 10 completed the columnar approach with a classification where the prognosis of injury is related to number of affected columns and displacement (less or more than 2 mm) instead of the diastasis between I and II TMT joints. Main and Jowett 13 developed a classification for Chopart injuries, where they stated that these injuries vary from small avulsion fragments to severe subluxation of the whole joint. Diagnostics have become more precise as a result of the more common use of computed tomography (CT). It is unclear whether there is such a type of injury as "purely ligamentous injury," or whether is it detectable from bony avulsion fragments. 7,8,17 The definitions and classifications of these injuries has changed, and still, 100 799741F AIXXX10.

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Injury Characteristics of Low-Energy Lisfranc Injuries Compared With High-Energy Injuries

Abstract: Level III, comparative series.

Cited by 43 publications

References 26 publications

Temporary Bridge Plating vs Primary Arthrodesis of the First Tarsometatarsal Joint in Lisfranc Injuries: Randomized Controlled Trial

Temporary Bridge Plating vs Primary Arthrodesis of the First Tarsometatarsal Joint in Lisfranc Injuries: Randomized Controlled Trial

Inter- and intraobserver reliability of non-weight-bearing foot radiographs compared with CT in Lisfranc injuries

Incidence and Characteristics of Midfoot Injuries

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