Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury

Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years （mean 32 years）. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents （3 cases）, fall from height （5 cases） and hit by heavy object （2 cases）. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days （average 6.6 days）. Postoperatively, the foot function was assessed using Visual Analogue Scales （VAS） and American Orthopaedic Foot and Ankle Society （AOFAS） Scales. Healing time and complications were observed. Results： All patients were followed up for 18-24 months （average 20 months）. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score （Z89 ± 0.34） and score at postoperative 8 weeks （0.67 ± 0.13）. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion： Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients＇ quality of life.

Clinical study on the surgical treatment of atypical Lisfranc joint complex injury

BACKGROUND Lisfranc injuries have not received much attention by orthopedic doctors in the past,and there is little related research on the diagnosis and treatment of these injuries.In recent years with the rise in foot and ankle surgery,doctors are now paying more attention to this type of injury.However,there is still a high rate of missed diagnosis due to insufficient attention causing treatment delays or inadequate treatments,which eventually result in greater sequelae;including long-term pain,arthritis,foot deformity etc.In particular,for cases with a mild Lisfranc joint complex injury,the incidence of sequelae is higher.AIM To select an active surgical treatment for an atypical Lisfranc joint complex injury and to evaluate the clinical efficacy of the surgical treatment.METHODS The clinical data of 18 patients,including 10 males and 8 females aged 20-64 years with Lisfranc injuries treated in our department from January 2017 to September 2019 were retrospectively analyzed.All patients were treated with an open reduction and internal fixation method using locking titanium mini-plates and hollow screws or Kirschner wires.X-ray images were taken and follow-up was performed monthly after the operation;the internal fixation was then removed 4-5 mo after the operation;and the American Orthopedic Foot and Ankle Society(AOFAS)score was used for evaluation on the last follow-up.RESULTS All patients were followed up for 6-12 mo.A good/excellent AOFAS score was observed in 88.9%of patients.CONCLUSION For atypical Lisfranc joint complex injuries,active open reduction and internal fixation can be performed to enable patients to obtain a good prognosis and satisfactory functional recovery.

A comparative study of the midfoot structure of humans and mice by CT measurement:Implications for employing a mouse model to study Lisfranc injury

Although midfoot injury,especilly Lisfranc sprain,is a relative rare traumatic pathology,if overlooked or treated incorrectly,the damage will develop into chronic Lisfranc injury,which is characterized by lifelong residual symptoms.The differences in injury severity,healing rates,treatment plans,and patient adherence make pro-spective investigations of the pathogenesis of Lisfranc injury very dificult to conduct.The development of ananimal model that mimics the symptoms of humans with chronic Lisfranc injury has the potential to lessen thechallenges associated with prospective human research.Previous research has successfully used a mouse model to explore the biomechanics of the human ankle joint.However,it remains to be determined if the mouse model canmimic human midfoot functions based on their similarities in anatomical structure.In this study,the anatomicalstructure of the mouse and human midfoot were compared by CT scan.The animal image data were obtainedfrom 10 male C57BL/6J mice(20 feet)by micro-CT.The human data were obtained from six volunteers(six feet)by CT scanning.The three-dimensional skeletal structure of the midfoot was reconstr ucted,and the morphologicalparameters were measured by a plane projection method.There were no significant differences among thehindfoot adductus angle(mice:28.86±6.27°;human:25.45±2.70°),metatarsus aductus angle(mice:11.34±2.95°;human:11.48±3.97°),or the transverse arch angle(mice:111.77±4.70°;human:111.84±6.34°)between the mice and humans.The mice had a comparable Lisfranc joint complex architecture compared tohumans in both coronal and transverse planes.The lateral cuneiform was fused with the navicular bone in mice,which would provide better intrinsic stability than in humans.Future research is necessary to evaluate the mouse midfoot injury model and the similarities of their neuro-musculo-skletal systems with humans.