Screw and Wire Fixation for Lisfranc Fracture Dislocations

Ghate, Sushant D; Sistla, Vidyasagar M; Nemade, Vijay Vasant; Vibhute, Dinesh; Shahane, Sunil M.; Samant, Ashwin

doi:10.1177/230949901202000207

Cited by 22 publications

(15 citation statements)

References 40 publications

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“…5 Despite nerve injury being a documented risk of this procedure, the rate of injury to the deep peroneal nerve has not been previously published in the literature. 3,4 This study allows for more accurate surgical consent of patients, with them being able to be informed that the rate of nerve injury is 11% for primary fixation of the Lisfranc complex, and if routine removal of hardware is planned, the overall rate of injury from both operations is 23%. Furthermore, patients who are undecided about whether to proceed with hardware removal after the primary surgery can be informed that the risk of nerve injury is 15% from the second operation.…”

Section: Discussionmentioning

confidence: 99%

“…5 Although some studies have reported that no patient developed a painful neuroma, the true rates of actual nerve injury (absent, altered, or painful sensation) have not been documented. 3,4 The current study investigated the rate of deep peroneal nerve symptoms following primary surgery and also after hardware removal for Lisfranc injuries.…”

Section: Introductionmentioning

confidence: 99%

“…10 Instability following injury requires anatomical reconstruction and intra-or extra-articular stabilization with screw fixation or bridging plates across the joints, leading to improved function. [2][3][4]8 Although routine removal of hardware is frequently performed around 3 to 4 months postoperatively, because there is little movement at the Lisfranc complex, it is not known if this is necessary. 10 The dorsal incision and dissection used to visually confirm accurate reduction of the injury and placement of hardware risks injury to the deep peroneal nerve.…”

Section: Introductionmentioning

confidence: 99%

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Deep Peroneal Nerve Injury Following Hardware Removal for Lisfranc Joint Injury

et al. 2019

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Background: Surgical exposure of the Lisfranc joint complex is within close proximity to the deep peroneal nerve, which can be injured in this approach. Common clinical practice is to remove Lisfranc hardware at 3 to 4 months postoperatively. However, it is unknown if this provides a clinical benefit or risks injury to the deep peroneal nerve. The rate of nerve injury is currently unknown from the published literature. This study clarifies rates of neurological injury to the deep peroneal nerve during primary surgery and hardware removal. Methods: This retrospective study was performed on all patients of a single surgeon from 2012 to 2018. Fixation was performed with locking plates or screws depending on the injury pattern. All patients who required open reduction and internal fixation routinely underwent hardware removal during this time. Neurological injury was assessed in a binary fashion (normal or abnormal) at 2, 6, and 12 weeks after the primary surgery and 2 and 12 weeks after hardware removal. McNemar’s test was performed to compare the rates of injury. Patients were contacted at a minimum follow-up of 15 months (range, 15-87 months) to assess persistent nerve injury and satisfaction. Fifty-seven patients with an average age of 29.8 years were included in the final analysis; all had documentation at 3 months postsurgery. Results: All patients had normal neurology before surgery. The rate of nerve injury for the primary surgery (11%) was significantly lower than the rate for patients with nerve injury following hardware removal (23%). However, the rate of spontaneous neurological recovery was low, with symptoms persisting in 5 of 6 patients between the primary operation and subsequent hardware removal. When these patients were excluded from the analysis, the rate of new nerve injury following hardware removal (15%) was not significantly different from the primary surgery rate. Seventy-one percent of nerve injuries persisted at the minimum 15-month final follow-up, with all patients with nerve injury being very or partially satisfied. Conclusion: The rate of deep peroneal nerve injury from primary Lisfranc fixation was 11%, and when routine hardware removal was planned the overall rate of nerve injury rose to 23%. This may be useful information during the patient consent process. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Deep Peroneal Nerve Injury Following Hardware Removal for Lisfranc Joint Injury

et al. 2019

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“…There may only be ligamentous injury, but if there is also direct bone injury, then it is easily diagnosed at the initial stage [7,8]. However, when the ligamentous complex is also damaged or a bone is injured alone, missed diagnosis or misdiagnosis can occur and lead to chronic pain and walking disorders after convalescence [9][10][11]. Open reduction and internal fixation are generally recommended for the treatment of Lisfranc joint injuries.…”

Section: Discussionmentioning

confidence: 99%

Effects of Acupuncture Treatment and Taping Therapy After Lisfranc Joint Injuries: A Case Report

et al. 2017

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“…Some researchers have proven that the Lisfranc ligament has the maximum width, thickness and cross-sectional area of all these ligaments, so its ultimate load is far higher than the others. 19 Reconstruction of the Lisfranc ligament is of great importance for the function of the foot. At present, the Lisfranc ligament is most commonly repaired by hollow countersunk screw inserted from the medial cuneiform to the second metatarsal base.…”

Section: Discussionmentioning

confidence: 99%