Midfoot fusion technique for neuroarthropathic feet:​ biomechanical analysis and rationale

Marks, Richard M.<sup>1</sup>; Parks, Brent G.<sup>2</sup>; Schon, Lew C.<sup>2</sup>

Affiliations

¹Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

²Department of Orthopaedic Surgery, The Union Memorial Hospital, Baltimore, Maryland

Abstract

To test the hypothesis that a plate applied to the plantar (tension) side of the medial midfoot provides stronger fixation than midfoot fusion with screw fixation, we biomechanically compared the two constructs for midfoot fusion. We created a model of midfoot instability in eight matched pairs of cadaver legs by section of joint capsule, ligaments, and tendons about Lisfranc's joints, and then performed a load-to-failure study to compare the fixation provided by a plantarly applied third tubular plate with that by cortical screws. After an initial load deformation curve to 1000 N was obtained, specimens were cyclicly loaded at 200 to 750 N for 3000 cycles and then loaded to failure (screw pullout, fracture, or deformation >3 mm). Comparing the plantar plate and midfoot fusion with screw fixation constructs, a plate applied to the plantar (tension) aspect of the medial midfoot provides a stronger, sturdier construct than does midfoot fusion with screw fixation.

Links

DOI: 10.1177/107110079801900801

PubMed: 9728696

WoS: 000075483600001

Cited By (10)

Year	Entry
2016	Huh J, Gross CE, DeOrio JK. Subtalar, Chopart, and Lisfranc joint degeneration. In: Valderrabano V, Easley M, eds. Foot and Ankle Sports Orthopaedics. Cham, Switzerland: Springer International Publishing; 2016:329-340.
2014	Hu S-j, Chang S-m, Li X-h, Yu G-r. Outcome comparison of Lisfranc injuries treated through dorsal plate fixation versus screw fixation. Acta Ortop Bras. 2014;22(6):315-320.
2006	Zgonis T, Roukis TS, Polyzois VD. Lisfranc fracture-dislocations: current treatment and new surgical approaches. Clin Podiatr Med Surg. 2006;23(2):303-322.
2006	Aronow MS. Treatment of the missed lisfranc injury. Foot and Ankle Clinics. 2006;11(1):127-142.
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2013	Eleftheriou KI, Rosenfeld PF. Lisfranc injury in the athlete: evidence supporting management from sprain to fracture dislocation. Foot and Ankle Clinics. June 2013;18(2):219-236.
2005	Alberta FG, Aronow MS, Barrero M, Diaz-Doran V, Sullivan RJ, Adams DJ. Ligamentous Lisfranc joint injuries: a biomechanical comparison of dorsal plate and transarticular screw fixation. Foot Ankle Int. 2005;26(6):462-473.
2013	Garchar D, DiDomenico LA, Klaue K. Reconstruction of Lisfranc joint dislocations secondary to Charcot neuroarthropathy using a plantar plate. J Foot Ankle Surg. May–June 2013;52(3):295-297.
2013	Eleftheriou KI, Rosenfeld PF, Calder JDF. Lisfranc injuries: an update. Knee Surg Sports Traumatol Arthrosc. June 2013;21(6):1434-1446.
2010	Panchbhavi VK, Villarreal AD. Treatment of acute Lisfranc fracture and dislocation in patients with neuropathy. Tech Foot Ankle Surg. 2010;9(3):115-122.