Abstract: neurological injury following metalwork removal for Lisfranc joint injury
ESSKA Academy. Maor D. Nov 9, 2019; 286372
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Abstract: neurological injury following metalwork removal for Lisfranc joint injury

AFAS Free Papers

Topic: Ligaments

Meyerkort D.1,2, Maor D.3,4, Calder J.5,6
1Perth Orthopaedic & Sports Medicine Centre, Perth, Australia, 2Fortius Clinic, Orthopaedics, London, Australia, 3Fremantle Hospital, Orthopaedics, Fremantle, Australia, 4Coastal Orthopaedics, Perth, Australia, 5Fortius Clinic, Orthopaedics, London, United Kingdom, 6Imperial College, Engineering, London, United Kingdom

Introduction: Surgical exposure of the Lisfranc joint complex is within close proximity to the deep peroneal nerve, which can be injured in this approach. Common clinical practice is to remove Lisfranc metalwork at 3 - 4 months post operatively. However it is unknown if this provides clinical benefit and risks injury to the deep peroneal nerve. The rate of nerve injury is currently unknown from the published literature. This study clarifies rates of neurological injury to the deep peroneal nerve during primary surgery and metalwork removal.
Objective: Assess the rates of nerve injury to the deep peroneal nerve for primary Lisfranc fixation and subsequent metalwork removal.
Aim: To assess if metalwork removal has an increased rate of nerve injury compared with primary fixation of the Lisfranc complex.
Method: This retrospective study was performed on all patients of a single surgeon from 2012 - 2018. Fixation was performed with locking plates or screws depending on injury pattern. All patients who required open reduction and internal fixation routinely underwent metalwork removal during this time. Neurological injury was assessed in a binary fashion (normal or abnormal) at 2, 6 & 12 weeks post primary surgery and 2 & 6 weeks post metalwork removal. McNemar's test was performed to compare the rates of injury.
Results: 57 patients with an average age of 29.8 were included in the final analysis. The type of fixation used is presented in Table 1. The rate of nerve injury for the primary surgery of 10.5% was not statistically different from the rate of new nerve injury for metalwork removal of 15.4% (p 0.449). The rate of spontaneous neurological recovery was low, with symptoms persisting in 5 / 6 patients between the primary operation and subsequent metalwork removal.
Conclusion: The rate of nerve injury from primary Lisfranc fixation of 10.5% was not significantly different to the rate of new nerve injury during subsequent metalwork removal of 15.4%. However this may be useful information during the patient consent process.
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