![]() In cases of ORIF, the implants were removed after 4–6 months (average 5.7 months).įor the surgical treatment, a reduction clamp was used to hold the position of the first and second metatarsal, one or two position screw/screws (depending on whether there is a diastasis between first and second cuneiform) were inserted. Of the 61 patients, 41 patients were managed conservatively while 20 patients received open reduction with internal fixation (ORIF). The choice of the management of either surgically or conservatively was finally decided by patients, after full explanation of the pros and cons of treatments. ‘Fleck sign’ is a small chip of bone found in the space between the first and second metatarsal bases, which indicates avulsion of the Lisfranc ligament. The cases inclusion criteria were as follows: no fractures in initial radio graphs the radiographic images showed that the first and second metatarsal had no diastasis (less than 2 mm in gap), but only weight-bearing view showed the diastasis more than 3 mm further images from CT showed some abnormality including ‘fleck sign’ or MRI showed plantar and interosseous branches of Lisfranc ligament rupture. For example, sports (soccer) injury, jump from a height, or a direct force applied to the foot from dorsal to plantar direction. The injury mechanisms were mainly foot sprain in the midfoot with a plantar flexion force. All the cases were undisplaced subtle ligamentous Lisfranc injuries, and the diagnosis was made by medical history taking, careful physical examination and further confirmed by stress view radiographs, CT or MRI. The study population consisted of 38 male and 23 female patients, with a mean age of 39.4 (range 19–64) years. The study was approved by the local Ethics committee, and a signed consent obtained from patients. Patients were treated in two orthopaedic centres (Beijing United Family Hospital and Tianjin Hospital, China). ![]() ![]() We also discuss the pros and cons of the treatment, which helps orthopaedic surgeons when faced with clinical decision of how to treat these injuries.Ī retrospective study of 61 patients who sustained undisplaced subtle ligamentous Lisfranc injury from May 2012 to May 2017 was conducted. The purpose of the study was to evaluate the outcomes of surgical and conservative management of undisplaced subtle ligamentous Lisfranc injuries. However, surgical or conservative management for undisplaced subtle Lisfranc injuries haven't been established yet and still controversial. 2 Recently, by utilizing computed tomography (CT) and magnet resonance images (MRI), the misdiagnosis rate has decreased and more subtle Lisfranc injuries have been recognized. The main reason for misdiagnosis is reported to be that 20%–50% Lisfranc injuries which showed no abnormalities in the initial radiographs. 1 Lisfranc injuries can result in a permanent source of foot pain and loss of normal gait, and dysfunction especially in sports activities. It is well described that as many as 20% of subtle ligamentous Lisfranc injuries are inappropriately treated either because of missed or underestimated the severity of the injury, and that often leads to poor clinical outcomes. The Lisfranc ligament is an interosseous ligament which locates between the medial cuneiform and the second MT. Lisfranc injuries have commonly been used to describe injuries to the bases of the five metatarsals (MTs) to their articulations with the four distal tarsal bones, which comprise tarsometatarsal joints (TMTs).
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