title: Combined Innovative Portal Arthroscopy and Fluoroscopy-Assisted Reduction and Fixation in Subtle Injury of the Lisfranc Joint Complex: Analysis of 10 Cases.
abstract: Subtle injuries of the Lisfranc joint complex are uncommon and difficult to diagnose clinically and thus are easily missed even by experienced orthopedic doctors. Misdiagnosed injuries can lead to chronic disability until eventual fusion surgery. We describe 10 cases diagnosed with subtle injury of the Lisfranc joint that were treated with combined innovative portal arthroscopy and fluoroscopy-assisted reduction and percutaneous screw fixation in an interfragmentary fashion. The distance between the first and second metatarsals (the Lisfranc distance) and that between the medial cuneiform and fifth metatarsal base (foot arch height) was measured before and after surgery. The American Orthopaedic Foot and Ankle Society function score was evaluated perioperatively. The average preoperative and postoperative Lisfranc distance was 4.38 ± 0.39 mm and 2.68 ± 0.9 mm, the foot arch height was 12.63 ± 2.75 mm and 21.80 ± 3.50 mm, and the American Orthopaedic Foot and Ankle Society score was 59.1 ± 5.69 and 86.8 ± 10.1, respectively. Of the 10 patients, 3 had excellent outcomes, 6 had good outcomes, and 1 had a fair outcome. In conclusion, we report a useful and minimally invasive surgery for acute, subacute, and even chronic subtle injury of the Lisfranc joint. The Lisfranc distance, foot arch height, and function of the foot were restored clinically, and all measurements showed statistically significant differences.
authors.affiliation: Surgeon, Department of Orthopaedic Surgery, Tri-Service General Hospital, Penghu Branch, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Shiu-Bii
authors.initials: SB
authors.lastname: Lien
authors.affiliation: Surgeon, Department of Orthopaedic Surgery, Tri-Service General Hospital, Penghu Branch, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Hsain-Chung
authors.initials: HC
authors.lastname: Shen
authors.affiliation: Associate Professor, Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China. Electronic address: LSB3612@yahoo.com.tw.
authors.forename: Leou-Chyr
authors.initials: LC
authors.lastname: Lin
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D001863:Bone Screws; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D018409:Foot Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008684:Metatarsus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D056888:Patient Positioning; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Lisfranc distance; Lisfranc joint complex; foot arch height; interfragmentary screw; subtle injuries