Design and Evaluation of the Kingston Brace

Lisfranc injuries affect at least 1 out of every 55,000 people each year. Although they are rare foot injuries, their effects can be devastating. 20-40% of Lisfranc injuries are missed upon first presentation. This increases the number of poor outcomes, resulting in a disproportionate number of malpractice lawsuits and compensation claims.

The Kingston Brace was designed to support an injured foot during a CT scan with the goal of providing the diagnosing physician with the best diagnostic information possible. A prototype was designed and built to support a variety of foot orientations in order to determine which orientation is optimal for Lisfranc joint CT scanning.

Three fresh frozen cadaver feet were put through several experiments with the Brace. The 2D diagnostic quality of CT scans taken using the Kingston Brace was compared against that of CT scans using the existing protocol. The Kingston Brace allows for a greater visualization of the injured Lisfranc joint than the existing CT protocol. Lisfranc joint spreading was used as a measure of potential pain in injured patients. The joint spreading was minimal, suggesting that injured patients would not feel as much additional pain during imaging. Also, the adoption of the Kingston Brace resulted in no change in the morphological parameters resulting from more advanced 3D analysis.

The experimentally determined optimal Kingston Brace orientation was found to be 9◦ of plantarflexion and 13◦ of eversion. These orientations can be incorporated into the next generation of Kingston Brace design.

Year	Entry
1963	Aitken AP, Poulson D. Dislocations of the tarsometatarsal joint. J Bone Joint Surg. 1963;45A:246-260.
1964	English TA. Dislocations of the metatarsal bone and adjacent toe. J Bone Joint Surg. 1964;46B(4):700-704.
1983	Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng. May 1983;105(2):136-144.
2006	Talarico RH, Hamilton GA, Ford LA, Rush SM. Fracture dislocations of the tarsometatarsal joints: analysis of interrater reliability in using the modified Hardcastle classification system. J Foot Ankle Surg. 2006;45(5):300-303.
2006	Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation: a prospective, randomized study. J Bone Joint Surg. 2006;88B(3):514-520.
2001	Kura H, Luo Z-P, Kitaoka HB, Smutz WP, An K-N. Mechanical behavior of the Lisfranc and dorsal cuneometatarsal ligaments: in vitro biomechanical study. J Orthop Trauma. February 2001;15(2):107-110.
2001	Chiodo CP, Myerson MS. Developments and advances in the diagnosis and treatment of injuries to the tarsometatarsal joint. Orthop Clin North Am. 2001;32(1):11-20.
2004	Calder JDF, Whitehouse SL, Saxby TS. Results of isolated Lisfranc injuries and the effect of compensation claims. J Bone Joint Surg. 2004;86B(4):527-530.
1999	Preidler KW, Peicha G, Lajtai G, Seibert FJ, Fock C, Szolar DM, Raith H. Conventional radiography, CT, and MR imaging in patients with hyperflexion injuries of the foot: diagnostic accuracy in the detection of bony and ligamentous changes. Am J Roentgen. 1999;173(6):1673-1677.
2007	Lattermann C, Goldstein JL, Wukich DK, Lee S, Bach BR Jr. Practical management of Lisfranc injuries in athletes. Clin J Sport Med. 2007;17(4):311-315.
2008	Lundgren P, Nester C, Liu A, Arndt A, Jones R, Stacoff A, Wolf P, Lundberg A. Invasive in vivo measurement of rear-, mid- and forefoot motion during walking. Gait Post. July 2008;28(1):93-100.
2004	Teo YH, Verhoeven W. Plantar dislocation of lateral tarsometatarsal joint: a case of subtle Lisfranc injury. Ann Acad Med Singapore. April 2004;33(3):362-364.
2008	Rammelt S, Schneiders W, Schikore H, Holch M, Heineck J, Zwipp H. Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation. J Bone Joint Surg. November 2008;90B(11):1499-1506.
2004	Haapamaki VV, Kiuru MJ, Koskinen SK. Ankle and foot injuries: analysis of MDCT findings. Am J Roentgen. September 2004;183(3):615-622.
2008	Panchbhavi VK, Andersen CR, Vallurupalli S, Yang J. A minimally disruptive model and three-dimensional evaluation of Lisfranc joint diastasis. J Bone Joint Surg. 2008;90A(12):2707-2713.
2002	Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D'Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion, I: ankle, hip, and spine. J Biomech. 2002;35(4):543-548.
2004	Sands AK, Grose A. Lisfranc injuries. Injury. 2004;35(2)(suppl 1):S-B71–S-B76.
2008	Benejam CE, Potaczek SG. Unusual presentation of Lisfranc fracture dislocation associated with high-velocity sledding injury: a case report and review of the literature. J Med Case Reports. 2008;2:266.
2007	Kaar S, Femino J, Morag Y. Lisfranc joint displacement following sequential ligament sectioning. J Bone Joint Surg. 2007;89A(10):2225-2232.
1997	Lu J, Ebraheim NA, Skie M, Porshinsky B, Yeasting RA. Radiographic and computed tomographic evaluation of Lisfranc dislocation: a cadaver study. Foot Ankle Int. 1997;18(6):351-355.
2008	Crim J. MR imaging evaluation of subtle lisfranc injuries: the midfoot sprain. Mag Reson Imaging Clin N Am. 2008;16(1):19-27.
1990	Nigg BM, Skarvan G, Frank CB, Yeadon MR. Elongation and forces of ankle ligaments in a physiological range of motion. Foot Ankle. August 1990;11(1):30-40.
1998	Burroughs KE, Reimer CD, Fields KB. Lisfranc injury of the foot: a commonly missed diagnosis. Am Fam Physician. 1998;58(1):118-124.
1982	Hardcastle PH, Reschauer R, Kutscha-Lissberg E, Schoffmann W. Injuries to the tarsometatarsal joint: incidence, classification and treatment. J Bone Joint Surg. 1982;64B(3):349-356.
2008	Gupta RT, Wadhwa RP, Learch TJ, Herwick SM. Lisfranc injury: imaging findings for this important but often-missed diagnosis. Curr Probl Diagn Radiol. May–June 2008;37(3):115-126.
2007	Coetzee JC, Ly TV. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. J Bone Joint Surg. March 2007;89A(pt 1)(suppl 2):122-127.
2007	Sherief TI, Mucci B, Greiss M. Lisfranc injury: how frequently does it get missed? and how can we improve? Injury. 2007;38(7):856-860.
1986	Myerson MS, Fisher RT, Burgess AR, Kenzora JE. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle. 1986;6(5):225-242.
2002	Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains. Am J Sports Med. November–December 2002;30(6):871-878.
2005	Saab M. Lisfranc fracture-dislocation: an easily overlooked injury in the emergency department. Euro J Emerg Med. 2005;12(3):143-146.

Year

Entry

1963

Aitken AP, Poulson D. Dislocations of the tarsometatarsal joint. J Bone Joint Surg. 1963;45A:246-260.

1964

English TA. Dislocations of the metatarsal bone and adjacent toe. J Bone Joint Surg. 1964;46B(4):700-704.

1983

Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng. May 1983;105(2):136-144.

2006

Talarico RH, Hamilton GA, Ford LA, Rush SM. Fracture dislocations of the tarsometatarsal joints: analysis of interrater reliability in using the modified Hardcastle classification system. J Foot Ankle Surg. 2006;45(5):300-303.

2006

Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation: a prospective, randomized study. J Bone Joint Surg. 2006;88B(3):514-520.