-
Foot (Edinburgh, Scotland) Dec 2020Lisfranc injuries encompass large spectrum of injuries varying from low energy to high energy complex fracture dislocations. Whilst multiple complex classification... (Review)
Review
BACKGROUND
Lisfranc injuries encompass large spectrum of injuries varying from low energy to high energy complex fracture dislocations. Whilst multiple complex classification systems exist; these do little to aid and direct the clinical management of patients. Therefore, this study aims to provide a simplified treatment algorithm allowing clinicians to standardise care of Lisfranc injuries.
METHODS
A comprehensive literature search was performed, and abstracts were reviewed to identify relevant literature.
RESULTS
Delay in diagnosis has a negative impact on outcome. If a Lisfranc injury is suspected and plain radiographs are inconclusive; computed tomography and if necessary magnetic resonance imaging are indicated if there is still an index of suspicion. In the absence of joint dislocation/subluxation management will be determined by stability which can be best assessed by weightbearing radiographs. If stable, injuries can be treated conservatively in a non-weight bearing cast for 6 weeks followed by a period of graduated weight bearing. Evidence is mounting that with regard to unstable purely ligamentous Lisfranc injuries primary arthrodesis (PA) has: better functional outcomes, increased cost effectiveness and reduced rates of return to theatre. With regard to bony unstable Lisfranc injuries more research is required before a single treatment modality - PA or open reduction internal fixation can be advocated, due to the lack of randomized control trials and limited patient follow-up periods in existing studies.
CONCLUSION
A simplified treatment algorithm excluding the requirement for complex classifications is suggested. This may help with the diagnosis and management of these injuries. It is our believe that this algorithm will aid health professionals to standardize care for these injuries. Further prospective research trials are required to assess outcomes of different modalities of operative management, particularly with regards to open reduction and internal fixation versus primary arthrodesis for bony Lisfranc injuries.
LEVEL OF EVIDENCE
Level 5.
Topics: Algorithms; Foot Injuries; Fracture Dislocation; Humans; Tarsal Joints
PubMed: 33038662
DOI: 10.1016/j.foot.2020.101719 -
Journal of the American Academy of... Dec 2021Subtalar dislocations are uncommon injuries that involve disruption of the talocalcaneal and talonavicular joints. Whereas medial subtalar dislocations are usually...
Subtalar dislocations are uncommon injuries that involve disruption of the talocalcaneal and talonavicular joints. Whereas medial subtalar dislocations are usually caused by low-energy mechanisms and are reducible by closed means, lateral subtalar dislocations occur due to high-energy trauma, have associated foot injuries, and may require open reduction. Good outcomes can be expected for low-energy medial dislocations, whereas high-energy dislocations have guarded outcomes. Hindfoot deformity and chronic instability can result from nonanatomic reduction and inadequate stabilization. Arthrosis of the subtalar joint can occur despite anatomic reduction and is attributable to the cartilage damage at the time of injury.
Topics: Foot; Foot Injuries; Humans; Joint Dislocations; Open Fracture Reduction; Subtalar Joint
PubMed: 34936582
DOI: 10.5435/JAAOSGlobal-D-21-00295 -
Theranostics 2020Gout, induced by monosodium urate (MSU) crystal deposition in joint tissues, provokes severe pain and impacts life quality of patients. However, the mechanisms...
Gout, induced by monosodium urate (MSU) crystal deposition in joint tissues, provokes severe pain and impacts life quality of patients. However, the mechanisms underlying gout pain are still incompletely understood. We established a mouse gout model by intra-articularly injection of MSU crystals into the ankle joint of wild type and genetic knockout mice. RNA-Sequencing, molecular imaging, Ca imaging, reactive oxygen species (ROS) generation, neutrophil influx and nocifensive behavioral assays, etc. were used. We found interleukin-33 (IL-33) was among the top up-regulated cytokines in the inflamed ankle. Neutralizing or genetic deletion of IL-33 or its receptor ST2 (suppression of tumorigenicity) significantly ameliorated pain hypersensitivities and inflammation. Mechanistically, IL-33 was largely released from infiltrated macrophages in inflamed ankle upon MSU stimulation. IL-33 promoted neutrophil influx and triggered neutrophil-dependent ROS production via ST2 during gout, which in turn, activated transient receptor potential ankyrin 1 (TRPA1) channel in dorsal root ganglion (DRG) neurons and produced nociception. Further, TRPA1 channel activity was significantly enhanced in DRG neurons that innervate the inflamed ankle via ST2 dependent mechanism, which results in exaggerated nociceptive response to endogenous ROS products during gout. We demonstrated a previous unidentified role of IL-33/ST2 in mediating pain hypersensitivity and inflammation in a mouse gout model through promoting neutrophil-dependent ROS production and TRPA1 channel activation. Targeting IL-33/ST2 may represent a novel therapeutic approach to ameliorate gout pain and inflammation.
Topics: Animals; Disease Models, Animal; Gout; Humans; Injections, Intra-Articular; Interleukin-1 Receptor-Like 1 Protein; Interleukin-33; Macrophages; Male; Mice; Mice, Knockout; Neutrophils; Pain; RAW 264.7 Cells; RNA-Seq; Reactive Oxygen Species; TRPA1 Cation Channel; Tarsal Joints; Uric Acid
PubMed: 33204337
DOI: 10.7150/thno.48028 -
Journal of Orthopaedic Surgery (Hong... 2023Subtalar instability is a confusing yet important condition in patients with lateral ankle instability. The author will explore subtalar kinematics, and how they are...
Subtalar instability is a confusing yet important condition in patients with lateral ankle instability. The author will explore subtalar kinematics, and how they are closely related to the joint stability of the subtalar joint, both with respect to its intrinsic ligaments and its extrinsic ligaments. As subtalar instability is difficult to diagnose, this article will provide readers with a better understanding of its clinical presentation. Discussions will also include useful radiographic modalities and the most recent evidence regarding their accuracy. The last section discusses surgical options and what the readers need to know in order to make a decision.
Topics: Humans; Ligaments; Joint Instability; Subtalar Joint; Biomechanical Phenomena; Ankle Joint; Ligaments, Articular
PubMed: 37449802
DOI: 10.1177/10225536231182350 -
Australian Family Physician Mar 2017Injury to the tarsometatarsal joint is a relatively rare occurrence that is commonly missed, leading to debilitating outcomes. For this reason, it is considered a red...
BACKGROUND
Injury to the tarsometatarsal joint is a relatively rare occurrence that is commonly missed, leading to debilitating outcomes. For this reason, it is considered a red flag in general practice.
OBJECTIVE
This article reviews the current literature on tarsometatarsal injuries and describes clinical assessment, imaging and management.
DISCUSSION
Lisfranc injuries refer to the displacement of the metatarsals from the tarsus, with special attention placed on the second tarsometa-tarsal joint and Lisfranc ligament. These injuries can occur in numerous circumstances, such as motor vehicle accidents, crush inju-ries and falls. Indirect mechanisms include axial force through the foot or twisting on a plantar flexed foot. Suggestive examination signs include plantar ecchymosis, mid-foot pain and positive findings in the provocative tests described in the article. Weight-bearing radiographs are vital for diagnosis. Correct and prompt management is key to avoiding posttraumatic arthritis, a devastating but common complication of Lisfranc injuries.
Topics: Australia; Clinical Competence; Family Practice; Foot Injuries; Humans; Joint Instability; Ligaments, Articular; Physicians, Primary Care; Tarsal Joints
PubMed: 28260272
DOI: No ID Found -
Journal of the Belgian Society of... 2023MCTO is a rare autosomal-dominant inherited disorder that causes bone destruction and deformity of the appendicular bones in children, with the carpal and tarsal bones...
UNLABELLED
MCTO is a rare autosomal-dominant inherited disorder that causes bone destruction and deformity of the appendicular bones in children, with the carpal and tarsal bones severely affected. Imaging can narrow the differential diagnosis between MTCO and other diseases that cause osteolysis of the joints in children. The MCTO diagnosis is confirmed by a mutation of the MAFB gene.
TEACHING POINT
Multicentric carpo-tarsal osteolysis (MTCO) in childhood must be considered in the differential diagnosis of severe osteolysis on radiographs.
PubMed: 36789404
DOI: 10.5334/jbsr.3018 -
British Journal of Hospital Medicine... Feb 2023Although uncommon, subtalar joint dislocations remain a frequently missed orthopaedic emergency. Detailed soft tissue and neurovascular assessment is important and these... (Review)
Review
Although uncommon, subtalar joint dislocations remain a frequently missed orthopaedic emergency. Detailed soft tissue and neurovascular assessment is important and these should be documented as appropriate. Failure of urgent reduction might lead to increased risk of conversion to an open injury as a result of pressure necrosis of the overlying skin, risk of talar avascular necrosis and risk of neurovascular compromise. A computed tomography scan is needed in all cases following successful closed or open reduction to identify associated occult foot and ankle fractures. The goal of treatment is to reduce the risk of soft tissue and neurovascular compromise and achieve a supple, painless foot. This article highlights the importance of early identification of this injury and institution of appropriate management according to the latest evidence, to reduce the risk of complications and lead to the best outcomes.
Topics: Humans; Joint Dislocations; Subtalar Joint; Ankle Fractures; Lower Extremity; Necrosis
PubMed: 36848162
DOI: 10.12968/hmed.2022.0211 -
Musculoskeletal Surgery Dec 2022Subtalar joint dislocation (1% of all dislocations) is the permanent loss of articular relationships in the talonavicular and talocalcaneal joints, without other... (Review)
Review
BACKGROUND
Subtalar joint dislocation (1% of all dislocations) is the permanent loss of articular relationships in the talonavicular and talocalcaneal joints, without other involvement of the foot. Dislocation can occur medially (85%), laterally (15%), posteriorly (2.5%) and anteriorly (1%). Reduction can be performed by closed or open technique; lateral dislocations often require open reduction because of inclusion of soft tissues or bone fragments. Lateral dislocations are frequently complicated by bone exposure, risk of infection and associated soft tissues injuries.
AIM OF THE STUDY
The aim of this study is to explain main characteristics and to clarify the most important pitfalls of subtalar dislocations.
MATERIALS AND METHODS
We examined 47 articles published in the last thirty years (389 cases). For each dislocation we reviewed its main characteristics: direction, bone exposure, need for open reduction and for surgical stabilisation, associated injuries and method used for diagnosis.
RESULTS
Medial dislocations (68.1%) has greater incidence compared to lateral ones (27.7%). Bone exposure (44.5%), associated lesions (44.5%) and need for surgical reduction (48.2%) are much more represented in lateral dislocation than in the others.
CONCLUSIONS
Subtalar dislocations, especially the lateral one, represent a challenge for surgeons. Lateral subtalar dislocation occurs following high-energy trauma often involving associated injuries. Closed reduction could be unsuccessful and patients must undergo surgical reduction. After reduction CT scan is recommended. Our narrative review confirms these findings.
Topics: Humans; Subtalar Joint; Joint Dislocations; Fractures, Bone; Tomography, X-Ray Computed
PubMed: 35435636
DOI: 10.1007/s12306-022-00746-x