Lisfranc injuries in sport.

Injuries to the Lisfranc ligament complex have traditionally been associated with high energy trauma such as motor vehicle collisions and industrial accidents. Recently, there has been a greater appreciation of mid-foot sprains that represent a spectrum of injury to the Lisfranc ligament complex. As a result, there has been an increased incidence of such injury resulting from low-energy trauma in activities ranging from recreational activity to elite athletic activity. This article discusses issues related to anatomy, clinical presentation, mechanism of injury, and diagnosis that are necessary to provide appropriate treatment for these injuries. There should be a high index of suspicion of this injury, and prompt diagnosis is important to allow athletes to return to sport with the best possible outcome.

Bunion surgery using locking-plate fixation of proximal metatarsal chevron osteotomies.

BACKGROUND: Symptomatic large hallux valgus deformities commonly require surgical intervention with a proximal metatarsal osteotomy. A number of fixation methods have been described for proximal chevron osteotomies; one of the most recent is locking plates. METHODS: We retrospectively reviewed the records of 16 consecutive patients (20 feet) with severe bunion deformities who had locking-plate fixation of proximal chevron osteotomies. Clinical evaluation focused on osteotomy healing, transfer lesions, and hardware-related complications. Preoperative and postoperative radiographic evaluation included the hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), medial 1-2 intermetatarsal distance (MIMD; the amount of narrowing of the foot), sesamoid position, first metatarsal elevation, and metatarsal length change. A postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was obtained in all patients. RESULTS: The average radiographic improvements were HVA, 16.0 degrees, IMA, 7.6 degrees, and MIMD, 9.0 mm. Sesamoid position improved in 16 of 20 feet. First metatarsal elevation averaged 0.8 degrees, and the average metatarsal shortening was less than 1 mm. The AOFAS score averaged 94.1 points. Two complications were unrelated to plate fixation. CONCLUSIONS: The locking plate held alignment and position of the first ray after chevron osteotomy without clinical evidence of transfer lesions or hardware-related symptoms. Locking plates may improve stability of the proximal metatarsal after a chevron osteotomy for correction of hallux valgus.