Questions and Answers
What does Fleck's Sign indicate?
What are some signs and symptoms of LisFranc Injury?
Ecchymosis, Edema, Midfoot pain, Compartment syndrome
What is the late treatment prognosis for LisFranc Injury?
Worse prognosis
What is Vassal's Principle related to?
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The 1st-3rd tarsometatarsal joints have ______ motion in the sagittal plane.
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LisFranc Injury most commonly presents in the ______ decade.
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What is the most effective imaging for an acute LisFranc injury?
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What is the goal of surgical treatment for LisFranc Injury?
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What are indications for surgery in LisFranc Injury?
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What complications can arise if anatomical reduction is not achieved in LisFranc injuries?
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When fixating a LisFranc injury, the procedure should go from ______ to ______.
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What sign indicates that swelling has decreased in a patient?
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What surgical goals are there for treating STJ dislocations?
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Which type of LisFranc Injury classification involves no diastasis?
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Study Notes
Fleck's Sign
- Indicative of a LisFranc injury.
- Characterized by a fragment of bone avulsed from the base of the 2nd metatarsal or 1st cuneiform.
Signs and Symptoms of LisFranc Injury
- Symptoms include ecchymosis, edema, midfoot pain, and potential for compartment syndrome.
Stress Maneuvers for LisFranc Injury
- Diagnostic tests performed in the operating room.
- Involves stabilizing the rearfoot and stressing the forefoot, assessing pain during the piano stress test.
Symptoms Indicative of LisFranc Injury
- Presence of ecchymosis, edema, midfoot pain, and pain elicited during stress maneuvers.
Late Treatment Prognosis
- Delayed intervention correlates with a worse prognosis.
Vassal's Principle in Midfoot Anatomy
- Major fracture fragments should be realigned, causing smaller fragments to align naturally.
Midfoot Injury Susceptibility
- Shallower recess in anatomy increases likelihood of injury.
Osseous Stability of the Midfoot
- Comprised of two arches (longitudinal and transverse) and three columns providing structural stability.
TMT Joint Soft Tissue Stability
- Ligaments across the TMT joint include strong plantar ligaments and weaker dorsal ligaments.
- Secondary stabilizers include the plantar fascia and peroneus longus tendon.
Tarsometatarsal Joint Motion
- The 1st-3rd tarsometatarsal joints exhibit minimal motion in both sagittal and frontal planes.
Age Demographics for LisFranc Injury
- Commonly presents in individuals during their 3rd decade of life.
Quenu and Kuss Classification
- Classifies injuries as homolateral, isolated, or divergent types.
Nunley and Vertullo Classification
- Stage 1 indicates no diastasis; Stage 2 indicates a ruptured ligament with 2-5mm diastasis; Stage 3 indicates both features plus loss of longitudinal arch height.
Hardcastle Classification
- Type A indicates total incongruity; types B1 and B2 denote partial incongruity with either medial or lateral dislocation; types C1 and C2 indicate partial and total displacement respectively.
Imaging Techniques for LisFranc Injury
- Definitive x-rays lead directly to surgery.
- Stress x-rays performed intraoperatively; MRI is best for chronic issues, while CT is preferred for acute presentations.
X-ray Findings in LisFranc Injury
- Look for diastasis greater than 1mm between intermetatarsal and intercuneiform spaces, and check for Fleck sign.
Surgical Indications and Goals for LisFranc Injury
- Indication for surgery includes any displacement, aiming for anatomic realignment.
- Non-displaced injuries require careful assessment of soft tissue stability.
Incision Strategies for Surgical Access
- Incision placement should avoid damaging deep peroneal nerve and deep plantar artery; careful placement can improve soft tissue preservation.
Forms of Fixation in LisFranc Surgery
- Options include K-wire only, screws with K-wire, bridge plate, or endobutton; the key focus should be on achieving anatomic reduction.
Surgical Treatment Varieties
- ORIF is ideal for lower energy injuries; primary arthrodesis is better suited for higher energy injuries requiring patient downtime.
Functional Outcomes Following Surgery
- Post-operative risks include post-traumatic arthritis, hardware complications, and loss of joint function.
Post-Operative Care
- Non-weight bearing (NWB) protocol for 8 weeks; gradual weight increase and physical therapy follow.
Midfoot and Navicular Fracture Classifications
- Various classification systems categorize fractures based on location and angulation, e.g., the Sangeorzan and Watson-Jones classifications for navicular fractures.
Treatment of Midfoot and Cuboid Fractures
- Surgical options include arthrodesis or arthroplasty; direct visualization is essential for complex fractures to ensure joint restoration.
STJ Dislocations Insights
- Dislocation direction is dependent on the relationship between distal and proximal parts; most common dislocation is medial (80%).
Closed Reduction Techniques for STJ Dislocations
- Specific steps vary for medial and lateral dislocations, emphasizing careful traction and adjustments to the position of the foot for optimal reduction.
Post-Reduction Management of STJ Dislocations
- Stable dislocations may simply require casting; if unstable, surgical intervention may be necessary through pinning or arthrodesis.
Complications of STJ Dislocation
- Risks include osteochondral lesions, open fractures, and soft tissue injury, which can complicate recovery and outcomes.
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Study key concepts related to LisFranc and midfoot fractures through this flashcard quiz. Understand important signs, symptoms, and diagnostic maneuvers associated with these injuries. Perfect for medical students or professionals looking to refresh their knowledge on midfoot trauma.
