Homolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study

Background: Lisfranc injuries encompass a spectrum of injuries to the tarsometatarsal (TMT) joint complex from ligamentous sprains to fractures with dislocation. While studies have shown it is possible to return to sport (RTS) after low-energy injuries, no literature exists demonstrating RTS after h...

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Autores principales:	Steven R. Dayton BA, Kurt M. Krautmann MD, Michael J. Boctor BA, Vehniah K. Tjong MD, Anish R. Kadakia MD
Formato:	article
Lenguaje:	EN
Publicado:	SAGE Publishing 2021
Materias:	Sports medicine RC1200-1245 Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/87f54da569ee417b95533dc4cb997c53
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spelling	oai:doaj.org-article:87f54da569ee417b95533dc4cb997c532021-12-02T23:03:19ZHomolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study2635-025410.1177/26350254211042885https://doaj.org/article/87f54da569ee417b95533dc4cb997c532021-10-01T00:00:00Zhttps://doi.org/10.1177/26350254211042885https://doaj.org/toc/2635-0254Background: Lisfranc injuries encompass a spectrum of injuries to the tarsometatarsal (TMT) joint complex from ligamentous sprains to fractures with dislocation. While studies have shown it is possible to return to sport (RTS) after low-energy injuries, no literature exists demonstrating RTS after homolateral fracture/dislocation of all 5 metatarsals. Indications: We present a novel technique for repair of homolateral Lisfranc fracture/dislocation of metatarsals 1-5 which may be used in high-level athletes attempting to return to competition. Technique Description: A dual approach is utilized, with a dorsal approach to allow for fusion of the 2nd and 3rd TMT joints and medial approach for internal bracing of the 1st TMT joint. The 2nd and 3rd metatarsals were denuded of all cartilage and the fusion site was fully prepared. Rigid fixation was applied to the fusion sites and then stability of the 1st TMT was reassessed. A guidewire for the cannulated InternalBrace (Arthrex; Naples, FL) system is initially inserted into the base of the 1st metatarsal. Positioning is confirmed with fluoroscopic imaging and the 3.4 mm drill is passed over the wire, followed by the cannulated tap. A 4.75 mm SwiveLock anchor (Arthrex; Naples, FL) with FiberTape suture (Arthrex; Naples, FL) is then inserted into the metatarsal base. The guidewire is placed in a reciprocating position on the medial cuneiform. The 2.7 mm drill is passed over the wire, followed by the 3.5 mm tap. A 3.5 mm SwiveLock anchor is then loaded with the FiberTape suture from the 1st metatarsal. Tensioning is performed, and the 3.5 mm SwiveLock anchor is inserted into the medial cuneiform. Results: The athlete was cleared to return to full competition 9 months following surgery. Physical examination demonstrated stability in dorsiflexion and abduction. Both weight-bearing x-rays and computed tomography scans showed no evidence of hardware failure, no instability of the 1st TMT joint, and solid fusion of the 2nd and 3rd TMT joints. Discussion/Conclusion: Current literature demonstrates that RTS is possible for athletes suffering from low-energy Lisfranc injuries. This novel surgical technique is the first to demonstrate return to sport of a high-level athlete from homolateral fracture/dislocation of all 5 metatarsals.Steven R. Dayton BAKurt M. Krautmann MDMichael J. Boctor BAVehniah K. Tjong MDAnish R. Kadakia MDSAGE PublishingarticleSports medicineRC1200-1245Orthopedic surgeryRD701-811ENVideo Journal of Sports Medicine, Vol 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Sports medicine RC1200-1245 Orthopedic surgery RD701-811
spellingShingle	Sports medicine RC1200-1245 Orthopedic surgery RD701-811 Steven R. Dayton BA Kurt M. Krautmann MD Michael J. Boctor BA Vehniah K. Tjong MD Anish R. Kadakia MD Homolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study
description	Background: Lisfranc injuries encompass a spectrum of injuries to the tarsometatarsal (TMT) joint complex from ligamentous sprains to fractures with dislocation. While studies have shown it is possible to return to sport (RTS) after low-energy injuries, no literature exists demonstrating RTS after homolateral fracture/dislocation of all 5 metatarsals. Indications: We present a novel technique for repair of homolateral Lisfranc fracture/dislocation of metatarsals 1-5 which may be used in high-level athletes attempting to return to competition. Technique Description: A dual approach is utilized, with a dorsal approach to allow for fusion of the 2nd and 3rd TMT joints and medial approach for internal bracing of the 1st TMT joint. The 2nd and 3rd metatarsals were denuded of all cartilage and the fusion site was fully prepared. Rigid fixation was applied to the fusion sites and then stability of the 1st TMT was reassessed. A guidewire for the cannulated InternalBrace (Arthrex; Naples, FL) system is initially inserted into the base of the 1st metatarsal. Positioning is confirmed with fluoroscopic imaging and the 3.4 mm drill is passed over the wire, followed by the cannulated tap. A 4.75 mm SwiveLock anchor (Arthrex; Naples, FL) with FiberTape suture (Arthrex; Naples, FL) is then inserted into the metatarsal base. The guidewire is placed in a reciprocating position on the medial cuneiform. The 2.7 mm drill is passed over the wire, followed by the 3.5 mm tap. A 3.5 mm SwiveLock anchor is then loaded with the FiberTape suture from the 1st metatarsal. Tensioning is performed, and the 3.5 mm SwiveLock anchor is inserted into the medial cuneiform. Results: The athlete was cleared to return to full competition 9 months following surgery. Physical examination demonstrated stability in dorsiflexion and abduction. Both weight-bearing x-rays and computed tomography scans showed no evidence of hardware failure, no instability of the 1st TMT joint, and solid fusion of the 2nd and 3rd TMT joints. Discussion/Conclusion: Current literature demonstrates that RTS is possible for athletes suffering from low-energy Lisfranc injuries. This novel surgical technique is the first to demonstrate return to sport of a high-level athlete from homolateral fracture/dislocation of all 5 metatarsals.
format	article
author	Steven R. Dayton BA Kurt M. Krautmann MD Michael J. Boctor BA Vehniah K. Tjong MD Anish R. Kadakia MD
author_facet	Steven R. Dayton BA Kurt M. Krautmann MD Michael J. Boctor BA Vehniah K. Tjong MD Anish R. Kadakia MD
author_sort	Steven R. Dayton BA
title	Homolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study
title_short	Homolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study
title_full	Homolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study
title_fullStr	Homolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study
title_full_unstemmed	Homolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study
title_sort	homolateral lisfranc dislocation 1-5 in a collegiate quarterback: a case study
publisher	SAGE Publishing
publishDate	2021
url	https://doaj.org/article/87f54da569ee417b95533dc4cb997c53
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Homolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study

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