Clinical Study on Different Methods of Internal Fixation for Treatment of Lisfranc Joint Injury

The Lisfranc joints are mainly used to connect the forefoot and midfoot and maintain the stability of the arch of the foot. It is an important part of the arch of the foot. If the Lisfranc joints injury is not treated in time, it will cause poor walking, pain in the back of the foot, and even deformity or disability of the forefoot. The common treatment method is to select the Kirschner wires, screws, or steel plates for incisional repositioning internal fixation surgery. In our study, we used different materials to perform fixation surgery on Lisfranc joint injury patients. We measured the joint recovery, pain condition, complications, and biomechanical indexes of different groups of patients after the operation. The results of the study showed that compared with Kirschner wire and screw internal fixation, the use of shaped arch bridge-type microsteel plate internal fixation for the treatment of metatarsotarsal joint injury patients has better foot function recovery, fewer complications, and more reliable biomechanical strength.

A Predictive Classification of Charcot Arthropathy of Foot and Ankle

Category: Diabetes; Other Introduction/Purpose: Charcot arthropathy of foot and ankle is a devastating, chronic and progressive destruction of bone and joint integrity affecting one or more joints. It is commonly associated with diabetes mellitus and is characterized by joint subluxations, dislocation, and pathological fractures in patients with peripheral neuropathy and results in a debilitating deformity, possibly leading to ulceration and amputation.Many classification systems exist for charcot arthopathy of foot and ankle. However, there is still lack of consensus regarding best classification. We are proposing a new classification for charcot arthropathy of foot and ankle based on our experience of large cohort of charcot patients. Our classification can guide treatment and prognosis of diabetic charcot arthropathy of foot and ankle, which we are following for the last decade. Methods: Patients with post-acute charcot who presented at our institution from January 2004 to October 2019 were reviewed and were further classified anatomically into Type I and Type II based on plain radiographs. Type I was characterized by charcot affection of one region. Regions were categorized anatomically as a modification of both Brodsky and Schon classifications into: ankle, Lisfranc (tarsometatarsal), naviculocuneiform, forefoot, and hindfoot which includes one of the following: talonavicular joint, calcaneocuboid joint or calcaneus. Type II was characterized by affection of more than one region like peritalar, perinavicular, transverse tarsal or any other combination. Peritalar complex involves at least two joints of the following: ankle, subtalar, and talonavicular. The perinavicular type includes talonavicular and naviculocuniform or tarsometatarsal and naviculocuniform, while the transverse tarsal involves the calcaneocuboid and talonavicu-lar. Both types were further classified into four stages according to the stability, deformity and associated mechanical ulcers. (Table 1) Results: 235 patients (242 feet) were presented with diabetic charcot arthropathy. Mean age was 56 years (range 22-84). Follow- up ranged from 6 months to 10 years, with a mean of 3.3 years.Types IA and IIA were managed conservatively. All patients in Type IIB, IC, IIC, ID, IID and the majority of type IB received fusion surgery to achieve stability and correction of deformity. Stage IB ankle were fixed, while IB lisfranc were observed, and fixed if transformed to IC.Type II D had the highest complication rate in the form of: infection, nonunion, nail protrusion, implant failure, revision including exostectomy after full union and recurrence of ulcer in midfoot 3-4 years after surgery. Five patients ended up with amputation, and all were stage IID. Conclusion: For post-acute charcot, stage A have the best prognosis and can be managed conservatively provided good diabetes control.Type IB can be managed conservatively but when the ankle is affected in type IB, it is better to be elected for surgery. When charcot affects the Lisfranc joints, it is usually stable unless the lateral column is affected.All cases of type IIB, IC and IIC, ID, IID should receive surgery to achieve stability, correction of deformity and prevent complications.Mechanical ulcer (stage D) carries the worst prognosis and highest complication rate. Type IID might predict the risk of amputation [Table: see text]

Total Loss of the Intermediate Cuneiform by Posttraumatic Avascular Necrosis: A Case Report

We report a unique case of the total loss of the intermediate cuneiform by posttraumatic avascular necrosis resulting from a left foot open fracture and dislocation of the navicular bone and medial and intermediate cuneiforms at the Chopart and Lisfranc joints in a 64-year-old woman. The injury was managed with open reduction and internal fixation with Kirschner wires and cannulated screws. During postoperative follow-up, we observed avascular necrosis of the intermediate cuneiform and the total loss of the bone. An extensive English literature search revealed only one case report published on this topic. Thus, we provide this case study to help guide clinical decision making in the future.

Feasibility of Transosseous Nonarticular Fixation of Lisfranc Injuries

Background: The optimal techniques for Lisfranc open reduction and internal fixation techniques remain debated. The purpose of the current study was to describe the joints involved in Lisfranc fixation and to determine if nonarticular transosseous internal fixation would be possible. Methods: Twenty cadaver Lisfranc joints were dissected and the articular cartilage was quantified by calibrated digital imaging software. Utilizing CT data, a computational model of the foot was developed and the mean joint surface was mapped and nonarticular screw paths between bones was determined. Results: For the medial-middle cuneiform (C1-C2) connection, 27.3% of the lateral face of C1 and 43.7% of the medial face of C2 was articular cartilage. Three variations of articular morphology were observed on C1 and 2 on C2. From the 3D models, it was determined that a joint-sparing, transosseous screw trajectory was possible between C1 and the second metatarsal and between C1 and C2. These screw paths were large enough to accommodate clinically useful screw diameters (>5 mm). The screw trajectories were roughly perpendicular to the long axis of the foot and take a plantar-medial to dorsal-lateral orientation. Conclusion: The articular surface of the Lisfranc joint was quantified for the first time and may be smaller than some surgeons realize. This study demonstrated the orientation required to minimize articular damage. Clinical Relevance: The clinical significance of the current study was that a nonarticular screw trajectory was possible, and this information may help guide the placement of these screws.

Dowel Arthrodesis for Degenerative Arthritis of the Tarsometatarsal (Lisfranc) Joints

A late complication of fracture with dislocation involving the tarsometatarsal joints of the foot (Lisfranc fracture) is progressive degenerative arthritis and pain. A dowel-graft arthrodesis technique is described that uses percutaneous bone graft from the iliac crest supplemented by crossed-wire fixation. The cases of 15 patients who underwent surgery between 1979 and 1982 in which this technique was used were reviewed retrospectively. These patients suffered from painful posttraumatic degenerative arthritis after tarsometatarsal joint fracture-dislocation. Follow-up evaluation (mean, 37 months) of 13 of the 15 patients demonstrated satisfactory pain relief in 11 patients, whereas 2 were dissatisfied. Complications included three instances of nonunion and one postsurgical reflex sympathetic dystrophy syndrome.