Return to Sports and Physical Activities After Open Reduction and Internal Fixation of Lisfranc Injuries in Recreational Athletes.

BACKGROUND: The purpose of this study was to assess participation in sport and physical activity following open reduction and internal fixation of a Lisfranc injury in a cohort of recreational athletes. METHODS: This study identified all adult patients aged 55 years or younger who presented with a Lisfranc injury and underwent open reduction and internal fixation (ORIF) using a Lisfranc screw combined with bridge plating technique. Sports and physical activity participation was assessed with a new sports-specific, patient-administered questionnaire. Clinical outcomes were assessed with the Foot and Ankle Outcome Score (FAOS). Thirty-three patients qualified for the study (21 men/12 women). Mean age and follow-up were 31.2 (range, 18-55) years and 2.9 (range, 1.5-5.4) years, respectively. RESULTS: Postoperatively, 31 patients (94%) were able to return to some form of sport. Twenty-two patients (66%) returned to playing sport at or above their preinjury level. Of the 11 patients who played less sport, 6 had ongoing pain, and the remaining 5 were asymptomatic but were participating less frequently because of other lifestyle reasons. In addition, of the 33 patients, 11 (33%) had some degree of ongoing pain that might limit their ability to return to sports and physical activities. There was strong correlation between overall FAOS and the Sports Questionnaire. CONCLUSION: Most patients who sustained a Lisfranc injury could return to sport and physical activity after ORIF. Patients should be counseled preoperatively that about 1 in 3 might experience continued pain at the injury site Level of Evidence: Level IV, retrospective case series.

Malleolar fracture after total ankle arthroplasty: a comparison of two designs.

There has been a resurgence in the treatment of end-stage tibiotalar arthritis with prosthetic replacement. This procedure has highlighted numerous complications including malleolar fracture. We wanted to determine the clinical relevance of malleolar fracture with the two most commonly used implants in the United States. We retrospectively compared the first 20 STAR with the first 25 Agility total ankle arthroplasties done by two surgeons. We examined the fracture rate, the timing, location, and treatment of the fracture, and the outcome in each group. In the Agility group, five fractures occurred, all intraoperatively. Four involved the medial malleolus and one involved the lateral malleolus. All fractures were fixed as implant stability was compromised. In the STAR group, there were four fractures. Two lateral malleoli fractured intraoperatively and were fixed. Two medial malleoli fractures occurred postoperatively and were treated nonoperatively. There was one medial malleolar nonunion in each group. The incidence of malleolar fracture was 20% in each group, comparable to results reported in relevant literature. We highlight some of the causes of malleolar fracture and describe our technique of prophylactic malleolar pinning to prevent this complication. Malleolar fracture is clinically relevant with the Agility and STAR implants and should be anticipated and prevented.