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Vinay Matai Journal Club 10/9/13

Purpose • To test the hypothesis that treatment of highenergy ligamentous LisFranc injuries with primary open reduction and internal fixation would have the same or better functional short and medium-term outcomes as treatment with a primary partial arthodesis. • Level I Study • No Disclosures by authors .

6m. 6w.Methods and Materials • • • • • • • Level of Evidence: I Study Type: Prospective Sample Size: 41 patients(Mar 1998 – Jan 2002) Follow up: 2w. 3m. 1yr. 2yr Groups: Arthrodesis vs Open Reduction Randomization: Even-Odd Numbering Patient Questionnaire – Satisfaction – Pain (0-10) – % of improvement in activity .

with no major fractures present . although all forty-one patients had the surgery within three weeks from the date of injury and most had it within the first week. • The Lisfranc joint injury had to be primarily ligamentous.Inclusion Criteria • Include all injuries that were seen up to one month after the accident.

ankle. or leg injury • Previous attempt at sx management of the same injury • T1DM • Ipsilateral ankle fusion • PVD • PN • RA .Exclusion Criteria • Comminuted intra-articular fracture at the base of the 1st or 2nd mets • Other substantial foot.

snowmobile. horse.4 (19-52) Follow up: 42 months • • • • • • ORIF Sx: Open Reduction with screw fixation of medial two or three rays. deep hole Mean Age: 32 (19-42) Follow up: 43. fall from height. 21 patients 14 men and 7 women MOI: MVC. Advanced to FWB over next 4 weeks in boot.4 Months *Post-Op: Short leg splint for 2 weeks NWB followed by short leg cast for 4-6 weeks NWB. sports Mean Age: 32.• • • • • • Arthrodesis SX: Primary arthrodesis of the medial two or three rays 20 patients 13 men and 7 women MOI: MVC. or all-terrain-vehicle accident. PT at week 6-10. fall from height. . snowmobile. or dirt-bike accident.

6 weeks • 19pts had uncomplicated fusion but 4 needed 2nd surgery for HR (6. increasing deformity.75m) Xray: loss of correction.Results Arthodesis • Sample Size: 21 • Fusion @ 10.5m) • 1 pt needed a bone stim healed • 1 required revision with bonegrafting and fusion healed • 1 pt with compartment syndrome healed • • • • • ORIF Sample Size: 20 16 underwent second surgery for HR (6. DJD in 15pts 5 pts tarsometatarsal arthodesis 2 scheduled for arthrodesis .

5 out of 6 patients that were dissatisfied underwent an arthrodesis and were satisfied .

ORIF: Only 6/20 were able to return to pre-injury level Arthodesis: 15/21 patients were able to return to pre-injury level .

1 @ 42 months • 3 of the 5 that had the conversion their AOFAS score was 79.6 @ 2 year • AOFAS: 57.9 @ 43 months ORIF • AOFAS: 68.0 .AOFAS and Pain Score Arthodesis • AOFAS: 88 @ 2 year • AOFAS: 86.

Limitations • Open-Randomization • Surgeon performed f/u exam • Comparison to patients with osseous deformity .