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Lisfranc Injury
Posted: Dec 1 2015 #(C2455)
A

Ligamentous Lisfranc Injury in 17M

HPI

Fall from 12 feet onto the left foot

PMH

None

PE

Skin intact, medial plantar ecchymosis, moderate swelling and tenderness over midfoot, neurovascularly intact

Poll
1 of 10
1. Assuming you only had the plain film radiographs of the foot shown above, would you obtain any additional imaging to guide management?
No - current radiographs are sufficient
19%
281/1467
Yes - additional radiographs (XR)
1%
16/1467
Yes - CT scan of the foot (CT)
61%
904/1467
Yes - MRI scan of foot (MRI)
5%
86/1467
Yes - CT + XR
5%
87/1467
Yes - MRI + XR
1%
19/1467
Yes - MRI + CT
2%
39/1467
Yes - MRI + CT + XR
0%
13/1467
Outside my area of expertise - best if I don't vote
1%
22/1467
2. Would you use a classification system to guide management?
No - a classification system would not help me
51%
711/1375
Yes - Quenu and Kuss
15%
210/1375
Yes - AO/OTA
16%
224/1375
Yes - Nunley and Vertullo
2%
39/1375
Yes - Other
2%
35/1375
Outside my area of expertise - best if I don't vote
11%
156/1375
3. How would you manage this patient?
Nonoperative
1%
27/1409
Operative
96%
1364/1409
Outside my area of expertise - best if I don't vote
1%
18/1409
4. If you choose Operative management, how would you definitively treat the medial and middle columns (1st-3rd tarsometatarsal joints)?
I would not choose Operative management
0%
3/1390
External fixation
0%
6/1390
Closed reduction percutaneous pinning (CRPP) only
15%
217/1390
Open reduction internal fixation (ORIF) (includes pinning of lateral foot)
66%
931/1390
Primary arthrodesis (includes pinning of lateral foot)
13%
183/1390
Outside my area of expertise - best if I don't vote
3%
50/1390
5. If you choose Open reduction internal fixation (ORIF), which approach would you use?
I would not choose ORIF
3%
41/1335
Single incision
23%
316/1335
Dual incision
67%
903/1335
Outside my area of expertise - best if I don't vote
5%
75/1335
6. If you choose Open reduction internal fixation (ORIF), what construct would you use for fixation of the medial and middle columns (1st-3rd tarsometatarsal joints)?
I would not choose Debridement and irrigation with modular component exchange
1%
14/1286
Screws (standalone) only
33%
433/1286
Staples only
1%
21/1286
Plate(s) only
3%
49/1286
Screw(s) + Staple(s)
8%
106/1286
Plate(s) + Screw(s)
41%
540/1286
Plate(s) + Staple(s)
1%
13/1286
Plate(s) + Staple(s) + Screw(s)
2%
36/1286
Outside my area of expertise - best if I don't vote
5%
74/1286
7. If you choose Operative management, how would you definitively treat the lateral column (4th and 5th tarsometatarsal joints)?
I would not choose Operative management
1%
16/1221
External fixation
0%
2/1221
Closed reduction percutaneous pinning (CRPP) only
53%
650/1221
Open reduction internal fixation (ORIF) (includes pinning of lateral foot)
39%
481/1221
Primary arthrodesis (includes pinning of lateral foot)
1%
20/1221
Outside my area of expertise - best if I don't vote
4%
52/1221
8. If you choose Operative management and attained the construct shown below, when would allow the patient to begin weight-bearing?
I would not choose Operative management
0%
2/1179
4-6wks
20%
238/1179
7-8wks
41%
491/1179
9-12wks
26%
310/1179
>12wks
9%
114/1179
Outside my area of expertise - best if I don't vote
2%
24/1179
9. If you choose Open reduction internal fixation (ORIF) of the medial and middle columns (1st-3rd tarsometatarsal joints), when would you remove THIS hardware?
I would not choose ORIF of the medial and middle columns
1%
19/1172
2-3mo
7%
84/1172
4-6mo
24%
292/1172
7-8mo
8%
103/1172
9-12mo
13%
160/1172
>12mo
20%
237/1172
Never
20%
245/1172
Outside my area of expertise - best if I don't vote
2%
32/1172
10. If you choose Closed reduction percutaneous pinning (CRPP) of the lateral column (4th and 5th tarsometatarsal joints), when would you remove THIS hardware?
I would not choose CRPP of the lateral column
1%
20/1163
3-4 weeks
6%
80/1163
5-6 weeks
42%
500/1163
7-8 weeks
28%
333/1163
9-12 weeks
9%
112/1163
>12 weeks
5%
65/1163
Never
1%
19/1163
Outside my area of expertise - best if I don't vote
2%
34/1163
PROCEDURE #1 DOP: 2/11/2015

ORIF with screws with single incision between the 1st and 2nd metatarsal and percutaneous pins for the 4th and 5th rays.

icon
OUTCOMES
Post-procedure P1
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