Fri., 10/15/10 Foot & Ankle, Paper #52, 11:48 am OTA-2010
Intraoperative Stress Examination of the Lateral Midfoot for Lisfranc Injuries (FDA=Non-U.S. research conducted within guidelines of my country)
Chris Steyn, MBChB, CCFP; David W. Sanders, MD, MSc, FRCSC;
University of Western Ontario, London, Ontario, Canada
Purpose: Operative treatment of Lisfranc joint injuries typically includes reduction and stabilization of the medial and middle columns of the midfoot. Mobility of the lateral column is preserved where possible, such that indications for lateral column stabilization rely upon the surgeon’s assessment of instability. In this case series, the indication for lateral column stabilization was defined by the results of an intraoperative stress test. The purpose of this study was to determine whether an intraoperative fluoroscopic stress test of the lateral column was sufficient to determine the need for internal fixation of the lateral column in Lisfranc joint injuries.
Methods: 35 adult patients with Lisfranc injuries operated in our center by a single surgeon from 2005 to 2009 were reviewed. All patients had unstable midfoot fracture dislocations, treated by reduction and internal fixation including an intraoperative stress examination to determine the need for lateral column fixation. Patients were contacted for clinical and radiographic review at a mean of 31 months after injury. Functional outcome was assessed using general and joint-specific outcome tools (American Orthopaedic Foot & Ankle Society [AOFAS] midfoot score, Short Form-36, and Lower Extremity Measure [LEM]). Radiographic review included analysis of joint displacement and arthritic changes in preoperative, postoperative, and most recent radiographs.
Results: Preoperative imaging demonstrated displacement of the lateral column in 25 of 36 patients. Of those 25, 19 had a stable anatomic reduction of the lateral column following medial and middle column fixation based upon an intraoperative stress examination of the lateral column. Only 6 patients with persistent instability on intraoperative stress examination were treated with lateral column stabilization. Reduction of the lateral column was maintained at final follow-up in 100% of 24 patients (1 patient in this group had later complications requiring amputation). Lateral midfoot pain was present in 5 patients requiring lateral fixation, compared to 1 patient who did not require lateral fixation. AOFAS midfoot scores (mean) were 80.12 in patients with no evidence of lateral column instability, 78.82 in patients with preoperative displacement but a negative stress examination, and 77.39 in patients requiring lateral fixation (P > 0.05). Posttraumatic arthrosis was present in the lateral column in 4 of the 19 patients.
Conclusion: The decision to stabilize the lateral column during surgery on Lisfranc injuries was aided by an intraoperative fluoroscopic stress examination. Based upon the stress examination, 19 of 24 patients who had a displaced lateral column at the time of presentation avoided lateral fixation. None of these 19 patients treated without lateral fixation lost reduction in the follow-up period. A fluoroscopic intraoperative stress test safely reduced the need for lateral column fixation in displaced Lisfranc joint injuries.
Alphabetical Disclosure Listing (292K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.