Treatment of Lisfranc Joint Injury: Current Concepts

Watson, Troy S.; Shurnas, Paul S.; Denker, Jacques

doi:10.5435/00124635-201012000-00002

Cited by 136 publications

(131 citation statements)

References 36 publications

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“…It is well known that injuries to the medial tarso-metatarsal articulation, or simply "lisfranc injuries" (or lfi) as they are commonly called; often go undiagnosed at initial presentation due to their deceptively normal appearing radiographs [1]. this is due, in most part, to the stability imparted on the midfoot by its anatomy [2].…”

Section: Introductionmentioning

confidence: 99%

“…this is due, in most part, to the stability imparted on the midfoot by its anatomy [2]. This can result in a near anatomic radiographic relationship of the nonweight-bearing midfoot, even in the face of significant ligamentous disruption [1,3] adding to the subtly of the injury is the low energy mechanism that can accompany this deceptively devastating injury. Unsuspecting injuries, which can be a result of a rotational mechanism, (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…Unsuspecting injuries, which can be a result of a rotational mechanism, (e.g. the midfoot rotating over the edge of a street curb while a patient suffers a low energy mechanical fall) can result in significant ligamentous injury to the tmt joint complex [1,3] such lowenergy trauma can then lull the initial treating physician, which is often a primary care physician (or pcp), into a false sense of relative security. This can lead to the misdiagnoses of patients with a lfi.…”

Section: Introductionmentioning

confidence: 99%

“…[1] These conditions are often refractory to operative management and in most cases, lead to chronic pain, losses in working productivity and large compensation claims [5]. This is in contrast to the relatively acceptable outcomes that patients can expect if a timely diagnosis and operative stabilization is achieved in less than 4-6 weeks [1]. It is for this reason that medical-legal claims are also not uncommon when a lfi has been missed [5].…”

Section: Introductionmentioning

confidence: 99%

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The Diagnosis and Initial Management of Injury to Lisfranc’s Joints in the Primary Care Setting in South-Eastern Ontario : How are we Doing?

R¹

2014

Clin Res Foot Ankle

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Objectives: Subtle Injuries to the Lisfranc's joint complex (or LFIs) can be difficult to diagnose on initial presentation to the primary care physician (or PCP). Significant research has gone into subspecialty imaging and operative management of LFIs. Little research, unfortunately, has gone into how PCPs, who are typically must initially suspect, and ultimately diagnose LFIs initially, perform when seeing cases typical of LFIs. Methods:A survey that assessed the diagnostic accuracy and management of LFIs in PCPs in Ontario was designed and validated. A final survey was circulated, via mail, to PCPs in southeastern Ontario. 189 of the 851 (22.2%) contacted PCPs responded to the survey. Demographic data was collected and compared to available information to ensure a representative sample. Results:With reference to subtle LFIs, A misdiagnosis of "soft tissue sprain" was made 35% of the time, while only 17% of respondents were able to correctly identify the unstable nature of the injury. 54% of responding PCPs indicated follow-up with an orthopaedic surgeon within the recommended two weeks. Conclusions:A directed educational intervention aimed at teaching PCPs in Ontario the principles for diagnosis and management of LFIs is indicated. These interventions may potentially help in increasing understanding and increasing the level of clinical suspicion when presented with the clinical scenario that can be associated with LFIs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Diagnosis and Initial Management of Injury to Lisfranc’s Joints in the Primary Care Setting in South-Eastern Ontario : How are we Doing?

R¹

2014

Clin Res Foot Ankle

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“…7 Options include closed reduction and percutaneous pinning, formal open reduction and internal fixation, or open reduction and arthrodesis of the affected joints. 8 Given the massive swelling of the foot, a closed reduction with the percutaneous placement of pins (also known as Kirschner wires, or K-wires) was performed ( Fig. 3E and 3F).…”

Section: Orthopedic Surgerymentioning

confidence: 99%

Case 11-2014

et al. 2014

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case records of the massachusetts general hospitalT h e ne w e ngl a nd jou r na l o f m e dicine n engl j med 370;15 nejm.org april 10, 2014 Pr esentation of C a seDr. John T. Nagurney (Emergency Medicine): A 34-year-old man was brought to the emergency department at this hospital because of multiple traumatic injuries that he sustained when a bomb exploded while he was watching the 2013 Boston Marathon. At the scene, the patient reportedly lost consciousness, had a complete amputation of his right leg directly below the knee, and had copious blood loss. A tourniquet had been applied to the right upper leg. He was placed on a backboard, immobilized, and transported to this hospital by ambulance, arriving at 3:20 p.m., 31 minutes after the explosion. He was brought immediately into a trauma bay in the emergency department. No additional history was known.On examination by Dr. Timothy Fallon (Emergency Medicine Resident) in the emergency department, the patient was covered with ash and smelled of smoke; he was somnolent but arousable to verbal stimuli, and he was oriented to date, self, and place (the hospital). The blood pressure was 98/52 mm Hg, the pulse 128 beats per minute, the respiratory rate 28 unlabored breaths per minute, and the oxygen saturation 100% (oxygen supplementation not recorded). He opened his eyes in response to speech. The Glasgow Coma Scale score was 14 on a scale of 3 (indicating coma) to 15 (indicating normal). There was soot and dirt on the face, and the nasal hairs and eyebrows were singed. The pupils were equal and reactive to light. The mucous membranes were dry. The cervical spine was not tender to palpation. The lungs were clear to auscultation, and there was no tenderness, crepitus, or deformity of the chest wall. The heart sounds were normal. The femoral pulses were 2+. The abdomen was soft, nontender, and nondistended, without guarding. The extremities were pale and cool. There was venous bleeding and a large pool of blood at the site of the amputation of the right leg, as well as an open fracture of the left foot. There were burns involving the face, trunk, and extremities; a puncture wound (3 cm in length) in the posterior aspect of the left thigh with some tissue destruction and no active bleeding; and multiple smaller penetrating wounds. Detailed wound and burn examinations were deferred. The patient moved all extremities and had no gross focal neurologic deficits.

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