Lisfranc Fixation Techniques and Postoperative Functional Outcomes: A Systematic Review.

The optimal method of fixation of acute Lisfranc injuries is yet to be established. We aim to systematically review the literature to identify the impact of fixation method on postoperative functional outcomes. A systematic review was undertaken using the PRISMA framework to identify all studies reporting postoperative functional outcomes in patients who underwent open-reduction internal fixation of acute Lisfranc injuries. Studies reporting outcomes of numerous fixation methods were divided into fixation subcohorts. Studies comparing bridge plate with transarticular screw fixation were included for meta-analysis, conducted using a random-effects model. Seventeen studies (20 subcohorts) with 462 patients were included. Mean patient age was 29.6 (rang, 15-81) years. Mean follow-up was 38.7 (range 11 to 287) months. American Academy of Orthopaedic Surgeons midfoot score (AOFAS-MF) was the most frequently reported functional outcome (16/20 subcohorts). Overall weighted mean AOFAS-MF was 76.3 ± 9.4 for all cases, with 74.2 ± 9.4 for transarticular screws and 79.2 ± 8.3 for bridge plates. The mean difference between screw and plate was not statistically significant (mean difference = 5.0, 95% confidence interval, -4.8 - 14.8, p = .3). A single study reported AOFAS-MF mean of 92 using suture button fixation. Meta-analysis of the 2 available comparative studies revealed higher postoperative AOFAS-MF with bridge plate fixation (pooled standardized mean difference, 0.51; 95% confidence interval, 0.15-0.87, p = .006). There is scarcity of literature examining the impact of fixation method on postoperative functional outcomes in acute Lisfranc injuries. A small number of studies have reported superior functional outcomes with use of bridge plate fixation. Further evidence is needed to ascertain which injuries are best managed with each fixation method or whether 1 fixation construct is universally superior.

Acromial fracture after reverse total shoulder arthroplasty: a systematic review.

BACKGROUND: The reverse total shoulder arthroplasty has become the most common method of arthroplasty of the shoulder. The complication of acromial or scapular stress fracture deserves consideration to describe incidence and determine whether prosthetic design or patient factors act as risk factors. METHODS: A systematic review of the literature was performed including the EMBASE, Medline and the Cochrane Library in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: The search returned 565 articles. After exclusion, 25 papers remained. In total, 208 fractures were reported in the literature, with an overall incidence of 5% and stress fractures were more common than post-traumatic ones; 24 fractures underwent osteosynthesis and there were nine revision arthroplasty surgeries. Outcomes worsened after fracture - whether treated with surgery or not. In patients with scapular base fractures, there was an improvement in functional outcome scores after surgery. Heterogeneous reporting of the risk factors prior to fractures, treatment methods and outcomes made recommendations weak. DISCUSSION: Acromial stress fracture after reverse total shoulder arthroplasty occurs relatively commonly but is poorly reported in the literature. It is unclear whether immobilisation, fixation or revision arthroplasty is the best treatment, although fixation may offer a better outcome. In future, reports should aim for greater consistency to allow a better understanding of this condition.

Modified Dorsal Approach in the Management of Lisfranc Injuries.

BACKGROUND: Open reduction and internal fixation of Lisfranc injuries has typically used multiple longitudinal incisions or a single transverse incision to approach the tarso-metatarsal joint (TMTJ). The incidence of wound-related complications is considerable. We describe a novel single-incision approach that utilizes subcutaneous windows to the medial TMTJ. METHODS: A retrospective review identified 150 patients who underwent open reduction and internal fixation for Lisfranc injuries, via the modified dorsal approach, at our center between January 2011 and June 2016. Removal of hardware (ROH) was routinely undertaken in 105 patients at a median of 210 days postoperatively. Medical records were reviewed to record patient demographics, mechanism of injury, and operative details. Outpatient notes were reviewed to identify wound-related complications, including delayed wound healing, superficial infection, wound dehiscence, deep infection, complex regional pain syndrome (CRPS), neuroma, and impaired sensation. Median age was 37 years (range, 19-78 years). Seventy-three percent of patients (110) were male. Most frequent mechanisms of injury were motor vehicle accident (MVA), 39%; motorbike accident (MBA), 19%; and fall, 18%. Sixteen percent (24) of injuries were open. Five patients required soft tissue reconstruction at the primary operation. Median follow-up was 144 (range, 27-306) weeks. RESULTS: Following the primary procedure, 14% of patients experienced wound-related complications including delayed healing (3%), superficial infection (5%), dehiscence (3%), complex regional pain syndrome (CRPS) (1%), and impaired sensation (1%). MBA injuries were at 15.1 times odds of superficial infection ( P =.01) than were MVA injuries. Following ROH, 13% of patients experienced wound-related complications, including delayed healing (2%), superficial infection (8%), dehiscence (1%), CRPS (2%), and neuroma (1%). Overall, 5 patients returned to surgery for soft tissue reconstruction for wound dehiscence. CONCLUSION: The modified dorsal approach using intervals to the midfoot offers a viable alternative with comparable wound complication rates to existing midfoot approaches. LEVEL OF EVIDENCE: Level IV, case series.

Patient-specific instrumentation for total shoulder arthroplasty: not as accurate as it would seem.

BACKGROUND: There is an increasing body of literature suggesting that the use of patient-specific instrumentation (PSI) in total shoulder arthroplasty (TSA) results in improved positioning of the glenoid component. The aim of this in vivo study was to assess the accuracy of PSI of the glenoid component in TSA in a consecutive series at a single center. METHODS: Eleven consecutive TSAs (7 TSAs and 4 reverse TSAs) were performed using custom-made patient-specific positioning guides for the glenoid component. Each patient had preoperative computed tomography scans and guides produced to allow 0° of glenoid inclination and version in anatomic TSAs and 10° of inferior inclination for reverse TSAs. Postoperative computed tomography imaging was performed to determine accuracy of component implantation. Patients were observed to the 1-year mark. RESULTS: For the conventional TSA group, the mean version was measured at 8° ± 10° retroversion and 1° ± 4° inclination. For reverse TSAs, mean version was 10° ± 10° retroversion and -1° ± 5° inclination. There were 5 cases classified as outliers in terms of version (>10° anteversion or retroversion). We had a mean correction of version of 22° ± 9° and 17° ± 9° in inclination compared with preoperative measurements. CONCLUSION: Our results suggest that the in vivo accuracy of PSI-guided glenoid positioning is not as successful as suggested in the literature.

Do columns or sagittal displacement matter in the assessment and management of Lisfranc fracture dislocation? An alternate approach to classification of the Lisfranc injury.

AIM: The classification of a Lisfranc injury has conventionally been based around Myerson's system. The aims of this study were to review whether a novel classification system based on sagittal displacement of the tarsometatarsal joint and breadth of injury as determined by a columnar theory was associated with functional outcomes and thus had a greater utility. PATIENTS: We retrospectively reviewed 54 Lisfranc injuries with a minimum follow up of two years at our Level One Trauma Centre. Each fracture was sub-classified based on our novel classification system which assessed for evidence of sagittal displacement and involvement of columns of the midfoot. Our primary outcome measures were the FFI and AOFAS midfoot scores. RESULTS: Injuries involving all three of the columns of the midfoot were associated with significantly worse functional outcome scores (FFI p=0.004, AOFAS p=0.036). Conversely, sagittal displacement, whether dorsal or plantar, had no significance (FFI p=0.147, AOFAS p=0.312). The best predictor of outcome was the quality of anatomical reduction (FFI p=0.008, AOFAS p=0.02). CONCLUSION: Column involvement and not sagittal displacement is the most significant factor in considering the severity Lisfranc injury and long term functional outcomes. This classification system has greater clinical utility than those currently proposed.

Marinomonas ostreistagni sp. nov., isolated from a pearl-oyster culture pond in Sanya, Hainan Province, China.

A Gram-negative, aerobic, halophilic, neutrophilic, rod-shaped, non-pigmented, polar-flagellated bacterium, UST010306-043(T), was isolated from a pearl-oyster culture pond in Sanya, Hainan Province, China in January 2001. This marine bacterium had an optimum temperature for growth of between 33 and 37 degrees C. On the basis of 16S rRNA gene sequence analysis, the strain was closely related to Marinomonas aquimarina and Marinomonas communis, with 97.5-97.7 and 97.1 % sequence similarity, respectively. Levels of DNA-DNA relatedness to the type strains of these species were well below 70 %. Analyses of phylogenetic, phenotypic and chemotaxomonic characteristics showed that strain UST010306-043(T) was distinct from currently established Marinomonas species. A novel species with the name Marinomonas ostreistagni sp. nov. is proposed to accommodate this bacterium, with strain UST010306-043(T) (=JCM 13672(T)=NRRL B-41433(T)) as the type strain.

Owenweeksia hongkongensis gen. nov., sp. nov., a novel marine bacterium of the phylum 'Bacteroidetes'.

An aerobic, Gram-negative, non-fermentative, rod-shaped, motile, orange-pigmented bacterium, UST20020801(T), was isolated from sea-water samples collected from Port Shelter, Hong Kong, S.A.R., China, in August 2002. The full 16S rRNA gene sequence of this strain shared only 87.5 % similarity with its nearest relative, Crocinitomix catalasitica, a species of the family Cryomorphaceae. However, strain UST20020801(T) possessed menaquinone-6, a major respiratory quinone of members of the family Flavobacteriaceae. This strain contains unique fatty acids such as i15 : 1G, i17 : 1omega9c, 2-OH 15 : 0, 15 : 1omega6c and three unknown fatty acids of equivalent chain-length of 11.543, 13.565 and 16.582. Further analysis of its ecophysiology and biochemistry suggests that this strain represents a new genus in the phylum 'Bacteroidetes'. The name Owenweeksia hongkongensis gen. nov., sp. nov. is proposed. The type strain is UST20020801(T) (=NRRL B-23963(T) = JCM 12287(T)).