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    Lisfranc Injury Fix or Fuse

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    Purushotham Nalamati
    This document discusses management of Lisfranc injuries, specifically whether to fix the injury with open reduction internal fixation (ORIF) alone or to also fuse the joints. It notes that Lisfranc injuries can be missed in 20% of cases and untreated in 40% of initial weeks. Failure rates are higher with poor reduction, fixation with K-wires or short screws, or other patient comorbidities. The document examines reasons to primarily fuse, such as in chronic, ligamentous, or intra-articular cases. Proper postoperative management and screw removal timing is also reviewed. The best approach depends on injury chronicity, severity, and patient factors.

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    Lisfranc Injury Fix or Fuse

    Uploaded by

    Purushotham Nalamati
    21 views19 pages
    This document discusses management of Lisfranc injuries, specifically whether to fix the injury with open reduction internal fixation (ORIF) alone or to also fuse the joints. It notes that Lisfranc injuries can be missed in 20% of cases and untreated in 40% of initial weeks. Failure rates are higher with poor reduction, fixation with K-wires or short screws, or other patient comorbidities. The document examines reasons to primarily fuse, such as in chronic, ligamentous, or intra-articular cases. Proper postoperative management and screw removal timing is also reviewed. The best approach depends on injury chronicity, severity, and patient factors.

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    lisfrancs ioacon 19.pptx

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    This document discusses management of Lisfranc injuries, specifically whether to fix the injury with open reduction internal fixation (ORIF) alone or to also fuse the joints. It notes that Lisfranc injuries can be missed in 20% of cases and untreated in 40% of initial weeks. Failure rates are higher with poor reduction, fixation with K-wires or short screws, or other patient comorbidities. The document examines reasons to primarily fuse, such as in chronic, ligamentous, or intra-articular cases. Proper postoperative management and screw removal timing is also reviewed. The best approach depends on injury chronicity, severity, and patient factors.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pptx, pdf, or txt
    21 views19 pages

    Lisfranc Injury Fix or Fuse

    Uploaded by

    Purushotham Nalamati
    This document discusses management of Lisfranc injuries, specifically whether to fix the injury with open reduction internal fixation (ORIF) alone or to also fuse the joints. It notes that Lisfranc injuries can be missed in 20% of cases and untreated in 40% of initial weeks. Failure rates are higher with poor reduction, fixation with K-wires or short screws, or other patient comorbidities. The document examines reasons to primarily fuse, such as in chronic, ligamentous, or intra-articular cases. Proper postoperative management and screw removal timing is also reviewed. The best approach depends on injury chronicity, severity, and patient factors.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    of 19

    Lisfranc Injury

    Fix or Fuse

    Dr. Francis Roy


    Chief surgeon, Emergency and Trauma care , Annai Velankanni Hospitals,
    Honorary Secretary, Tamilnadu orthopaedic association
    CEO, Annai Velankanni ORGANISATIONS

    FOOT HEALTH RESOURCE CENTER


     2 Management Pathways
     ONLY ORIF – Fix group
     ORIF + FUSION – Fuse group
     Why does it fail??
     Post op protocol
     2 clinical scenario’
     Chronic
     Acute

     20% misdiagnosed
     40% no treatment 1st week
     20 % are missed on initial x ray
     Long rehab
     Changes Lives
    Early diagnosis
    •Poor Reduction
    •Closed Reduction
    •Percutaneous Reduction
    •Bad technique ORIF
    •Plantar aspect poor reduction

    •Poor stability
    •K-wire / short screws.

    •Other co-morbidity
    •Hyper Mobility
    •Gastrocnemius equines contracture ( Root of all evil)
    •Increased stress in the Tarso metatarsal joint

    So fusion Better or just fixation??

    Why Faliure??
    Postoperative Management
    •Slab 10 –14 days, non- weight bearing
    •Short leg cast, non- weight bearing 4 – 6 weeks
    •Mid foot off loading footwear or brace for an
    additional 4 – 6 weeks
    •Arch support for 3 – 6 months
    •2 surgery – screw removal
    nd

    – Lateral column stabilization can be removed at 6 to 12


    weeks
    – Medial fixation should not be removed for 4 to 6
    months especially plates
    •Can leave screws indefinitely unless symptomatic
    Fuse & Fix !!
    •Late presentation
    •More Than 3 Weeks
    •Pure Ligamentous
    •Bony–ligamentous Injuries
    •“ORIF + FUSION

    Chronic
    NEGLECTED CHRONIC LISFRANCS
    •Chief Complaints - Left foot
    pain - 8 months.

    •Alleged h/o twisting injury


    to left foot

    •Conservative treatment -
    crepe bandage& analgesics

    •Developed deformity of foot


    & pain on weight bearing
    Weight bearing AP X- ray

    COLLAPSED
    MEDIAL ARCH

    Prominence At
    The Medial
    Border With
    Slight Abduction
    At The Forefoot
    FUSION + FIXATION
    ORIF fix ONLY ??
    •ORIF - gold standard
    •Trans articular screw fixation
    •Screws - further damages the articular
    surfaces
    •Bridge plating - Fracture comminution
    •Optimal screw size –3.5 or 4mm screws
    •Long-term effect of primary fusion unknown
    adjacent joint arthritis
    •Can always fuse if FAILS
    •Higher rate of need for implant removal
    •19% go for arthrodesis
    ACUTE
    CAN WE PRIMARLY Fuse?
    •Limited inherent motion- non essential joint
    •Bones heal but ligaments healing??
    •Primary arthrodesis- limited loss of motion & function
    •Pure Ligamentous medial & middle columns
    •Intraarticular fractures
    •Associated foot injuries
    •Poly trauma

    ACUTE
    ACUTE - Fuse & Fix ??
    •Mr.DD, 55/m
    – H/O RTA fall - 2 wheeler
    – Injury to right foot
    – Difficulty in walking since
    fall
    – No medical co- morbidities

    •On examination
    – Swelling of right foot
    – Tenderness at Lisfranc joint
    – Distal pulses intact
    – Ankle rom - normal
    ACUTE - Fuse & Fix
    •KUO – 2000
    – Study on outcome following ORIF
    – Sub- group - Purely ligamentous
    Do poorly
    – No difference between 2 groups in
    developing arthritis in osseous or
    ligamentous injury
    •Anatomic reduction important
    •They also stressed need for two screws
    & they used 3.5mm

    Can we Fix ??
    CAN
    we primary Fuse? • Electively fusion – Hallux Valgus
    •Tye.J – et.all 1989 Foot & Ankle Journal
    – Movements of the TMT joint
    – 2nd MT – 0.6 Sagittal plane excursion
    – 3rd – 1.6 Ist – 3.5
    •Non- essential joint
    •Lee – et.all
    – 25 % Only ORIF - Later needed Fusion
    – 75 % Screw removal Vs 19 % - Arthrodesis.
    – Primary Arthrodesis Vs Only ORIF much better
    •May be due to development of degeneration
    •Henning / Cliff Jones et all – 2007
    – 14 Patients
    – No difference in clinical outcome
    •All studies 5yrs follow up long term not know
    Is fusion always necessary:
    •A good ORIF is difficult
    •A good Mid foot fusion is also challenge.
    •Doing it in the same time
    •Acute setting is it possible.
    •Calcaneal fracture fixation
    do you do Subtalar fusion
    • Maintaining normal anatomy
    • Can fuse when needed…

    Why JUST Fix ??


    To Fix or Fuse !!
    Anatomical Reduction

    WIDE VARIETY of injury patterns


    Young
    Old
    Diabetic
    Middle aged
    Purely ligamentous
    High velocity
    ONLY ORIF or ORIF + Fuse !!
    •Timing
    – Chronic injury
    – Acute injury
    – Associated injury
    •Type - Severity
    – Purely ligamentous
    – Osseous
    – Osseo ligamentous
    – Intraarticular fractures
    •Co – morbid’s
    – Age
    – Urban Athletic
    – Smoker
    – Diabetic
    To FIX or TO Fuse !!

    PERSONALITY OF INJURY
    How many to fuse!!
    Thank
    you

    FOOT HEALTH RESOURCE CENTER

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