Lisfranc fracture

Răzvan Codrin Bandac 1 1 Grigore T. Mechanisms of injury are direct and indirect, including traffic accidents and sports. Clinical signs and symptoms are: midfoot pain, inability to bear weight, leg deformity and swelling, and plantar ecchymosis.

Pedal artery or deep peroneal nerve may be lisfranc fracture and the compartment syndrome may occur. Radiographic incidences reveal changes and dislocations in tarsometatarsal interlining. Stress radiographs are helpful in unstable lesions.

CT is used for diagnosis and preoperative planning. Lisfranc injury classifications can not determine the treatment or suggest prognosis.

Medial and middle columns are fixed with 3. Postoperative care includes early mobilization, progressive weight-bearing, and osteosynthesis material removal.

MODERN DIAGNOSTIC AND TREATMENT PRINCIPLES OF LISFRANC MIDFOOT DISLOCATIONS IN ATHLETES

Primary tarsometatarsal arthrodesis is an alternative in lesions with severe joint damage. Immediate complications are common, including neurovascular injury and compartment lisfranc fracture, and late complications are posttraumatic midfoot arthrosis, algoneurodistrofic syndrome, chronic foot pain, implant deterioration. Patients require a long rehabilitation period. The incidence of posttraumatic arthritis is high, due to damaged articular surfaces, comminuted fractures, or due to side movements, results of unstable osteosynthesis.

Key words: Lisfranc joint complex, tarso-metatarsal dislocation, internal fixation, midfoot osteoarthritis. This term is used today to describe a wide spectrum of traumatic lesions to this region of the foot. Specialists concern for midfoot trauma is generally quite limited, inevitably leading to a inadequate knowledge and treatment of these lesions. Thus, Di Giovanni [1] noted a marked increase lisfranc fracture the incidence of foot injuries due to increased frequency and severity of road accidents, and also more associated multiorgan injuries in polytrauma.

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This often puts in difficult situations the medical team, which has to act quickly in chosing the therapeutic maneuvers needed to maintain vital lisfranc fracture, and minimizing the treatment of leg trauma. Further course is burdened by severe pain and severe homolateral leg dysfunctions [3,4], with a psycho-socio-economic impact on the quality of life stronger than with any other injury.

Also, the widespread practice of collision sports, such as rugby, American [5,6] or even European football has led in recent decades to an increase in the incidence of midfood injuries, from simple, classified as midfoot sprains with different degrees lisfranc fracture severity, to complex midfood injuries dislocations and fracturedislocationposing serious diagnositic lisfranc fracture treatment problems. Heckmann and colleagues explain the need for an as accurate orthopedic or surgical treatment as posible for ensuring perfect alignment of the injured structures, given the extremely complex biomechanics of the foot that does not allow imperfections [7,8].

Strict observance of the therapeutic principles gives satisfactory results, reducing the immediate circulatory disorders, skin necrosisbut also late arthritis, stiffness, vicious calluses complication rate [9,10].

Chapman and colleagues provide an important contribution by presenting detailed notions of biomechanics of the foot for each traumatic areas [5], and related to the pathophysiologic mechanisms of injury.

These are corroborated with modern imaging methods lisfranc fracture obtaining more precise data about disturbances in osteoarticular biomechanics, aimed at initiating immediately an accurate treatment for each injury type [1]. Last, but not least, Greer Richardson, in his "Fractures and dislocations of lisfranc fracture foot, reviews thoroughly foot injuries on targeted osteoarticular segments, lisfranc fracture on their biomechanic involvement in the entire complex [5, 7].

The most important contribution is the meticulous clinical-anatomical classification of every entity, thus offering support for lisfranc fracture treatment of every anatomic injury [10] and goal is to obtain a very good 46 2 surgical result, that is a correct osteoarticular alignment, by the standardization of both the approach route and of the means and methods lisfranc fracture internal and lisfranc fracture fixation in relation with the type of injury according to the anatomical-clinical classification [4].

Currently, the surgical means of internal and external fixation associated to bone and soft tissue reconstruction in the complex trauma of the foot are presented in detail [7[. The first three metatarsals articulate with the three corresponding cuneiforms: medial, middle and lateral. The fourth and fifth metatarsals articulate with the cuboid bone Figure 1.

1. Ce unguent când rănesc articulațiile
2. Luxația tratamentului unguent articular al cotului
3. Aim: To assess the functional outcome of patients with Lisfranc dislocations of the midfoot by applying the latest methods of diagnosis and treatment.
4. Artroza lisfranc Tarsometatarsal Joints and Midfoot Lisfranc Sprains artrita artroza deget mare Departamentul de Chirurgie Ortopedica al clinicii Centrokinetic este dedicat sa ofere ingrijire excelenta pacientilor si educatie de exceptie pentru medicii tineri, in domeniile chirurgiei Artroza lisfranc si a medicinii musculo-scheletice.

Figure 1 Lisfranc joint - osteo-ligamentous lisfranc fracture [5] Bone alignment of this articular complex is particularly important in understanding the therapeutic considerations of this region [1,3]. Intrinsic stability is due both to the cum să identifice artroza articulară location of the second metatarsal base, and even more to the strong ligament complexes attached to every tarsometatarsal joint.

Lisfranc ligament, the strongest ligament of this ligament complex, originates in the plantar-lateral aspect of medial cuneiform and inserts into the plantar-medial of second metatarsal base [4] Pedal artery crosses the midfoot right above the second tarsometatral joint, being particularly predisposed to destruction during Lisfranc injuries, often associated with the onset of compartment syndrome.

Deep peroneal nerve, providing innervation to the first intermetarsian space, can also be injured [2]. The study of this joint mobility shows two lisfranc fracture components [4. Medial column which is a continuation of the talus, scaphoid and the three cuneiforms with their corresponding metatarsals and lateral column, represented by the calcaneus, cuboid and two lateral metatarsals. The three medial joints have less mobility, equal to one third of lisfranc fracture mobility in the two joints that form the lateral column.

Artroza lisfranc

The relative medial rigidity is particularly important in lisfranc lisfranc fracture regional stability. This allows the distal tendon insertions of the anterior calf muscle and long lateral peroneal muscle to change the position of the first ray, allowing the positioning lisfranc fracture the first metatarsal head during forefoot ground support, depending on lisfranc fracture type of terrain.

Lateral column is also an area of insertion for exremely strong intrinsic muscle groups, distal tendons of the short lateral peroneal and posterior calf muscles, respectively, in the fifth metatarsal base, providing stability and positioning during walking to the lateral column [2,4].

By contrast, the fourth and fifth tarsometatarsal joints are major points of lateral column mobility, mobility being crucial for the normal function of the foot. The frequency of these injuries increased primarily due to the increasing incidence of road, work and sports accidents. Although known to be a rare lesion, this was due to diagnostic difficulties. Direct load of the ligament complex along the dorsal aspect of the foot, as in crush injuries, or when a heavy object is falling on the foot on the ground, can result in fracture- dislocations anywhere in this articular complex.

The type of injury depends on the point of force application, often the association of soft tissue destruction complicating even more the treatment. Figure 2.

Thus, typical is the sports field 47 3 mechanism of injury, especially in lisfranc fracture, namely, when a player is with his foot on the ground and another player forcefully steps on the midfoot area of his foot [6,10]. Indirect load is the most common mechanism of injury, producing the most significant changes in the entire complex, usually by longitudinal loading of the foot in plantar flexion 3.

This leads to association of the dorsal ligaments and then of the plantar ones resulting in varying degrees of bone injuries.

LISFRANC MIDFOOT DISLOCATIONS: CORRELATIONS BETWEEN SURGICAL TREATMENTAND FUNCTIONAL OUTCOMES

This is the most common mechanism in sports accidents Figure 3. Lisfranc fracture 3 Lisfranc trauma: indirect mechanism of injury 11 Lisfranc injury occurs in the presence of a force and torque lisfranc fracture forefoot and midfoot.

Thus, athlete s forefoot is stuck on the ground, and his whole body weight exerts a twisting force resulting in midfoot twinsting while forefoot is immobilized.

For example, the horseman falls off a horse and his foot stays locked in the stirrups, or the windsurfer falls off the board but his foot remains in the board stirrup.

Traducere "Lisfranc" în română

Also, in football players, these injuries frequently occur when his foot in stuck in the turf and he suddenly rotates when changing direction, or his foot is blocked by another player s foot [6,10]. Recent studies have revealed no relationship between the injury mechanism and type of injury [3,5]. Clinical diagnosis is based on a thorough physical examination of the injured leg. In isolated lesions, pain along the lisfranc fracture complex suggests the presence of a possible injury.

In athletes, immediately after trauma the injured leg is swollen and even deformed in the medial area, with severe spontaneous pain on midfoot palpation and associated with total functional impairment of this area causing inability to bear weight.