PURPOSE OF THE STUDY: Lisfranc is a challenging injury both diagnostically and surgically, with sparse long-term literature evidence of surgical practice. We aim to review our long-term specialist orthopaedic institutional experience of Lisfranc injuries and the surgical management of this complex injury, specifically considering surgical outcomes as per radiological and clinical assessment. MATERIAL AND METHODS: We present data from a prospectively maintained institutional database, reviewing patients who underwent operative fixation for Lisfranc injury between April 2014 and August 2020. Patients were referred to our institution from hospitals across the country. We included all operatively managed Lisfranc injuries, primary procedures, and patients over the age of 16. Revision procedures, open injuries, polytrauma patients, patients under the age of 16, and those with multiple foot injuries were excluded. We assessed post-operative results as per the Wilpulla radiographic and clinical criteria. RESULTS: We treated 27 patients across the study period, of mean age 37.5 (SD 18.3), 55% male and 45% female. 33.3% of our patients were obese as defined by body mass index >30. As per the Myerson classification, we had 2 category A, 24 category B, and 1 category C injuries. Time to operation was median 14 days (range 0-116), with 2 delayed presentations following failure of conservative treatment. Our median length of stay was 1 day (range 0-16). We had 3 complications: 2 wound infections and 1 re-operation for non-union. Post-operative assessment as per Wilpulla demonstrated 74% of good, 18.5% fair and 7% poor fixation results. CONCLUSIONS: In our institutional experience, partial congruity lateral displacement injuries were the majority of surgical referrals. Surgical treatment through open reduction and internal fixation delivers good clinical and radiographically anatomical results. Further to conventional mechanisms of injury, we propose obesity to be an important risk factor for indirect, low-energy injuries that may help identify this injury. KEY WORDS: Lisfranc injury, long-term, orthopaedic surgery, obesity.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• metatarzální kosti zranění   chirurgie   diagnostické zobrazování   MeSH
• mladý dospělý MeSH
• pooperační komplikace etiologie   MeSH
• poranění nohy (od hlezna dolů) chirurgie   diagnostické zobrazování   MeSH
• retrospektivní studie MeSH
• vnitřní fixace fraktury * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The aim of our study was to compare gait in terms of foot loading and temporal variables after 2 different operative approaches (the extended lateral approach [ELA] and sinus tarsi approach). Twenty-two patients who sustained an intra-articular calcaneal fracture underwent plantar pressure distribution measurements 6 months after surgery. Measurements were performed while patients walked on the pedobarography platform. The values of dynamic variables were significantly lower on the operated limb in the ELA. In the sinus tarsi approach, no differences were observed between the operated and uninjured limbs (UIN) at peak pressure and at maximal vertical force. The values of temporal variables (contact time of the foot and of the heel) between the operated and UIN differed in the ELA. The hypothesis that differences in foot load between operated and UIN will be more significant in the ELA was confirmed. Our results showed that the differences in loading and temporal variables between the operated and the UIN persisted 6 months after surgery in both methods. The operated limb was less loaded, with the tendency to shift the load toward the midfoot and forefoot. After the less invasive sinus tarsi approach, the dynamic and temporal variables on the operated limb were nearly the same as those on the healthy one. The sinus tarsi surgical approach can be recommended for treatment of displaced calcaneal fractures.

• Klíčová slova
• extended lateral approach, force, pedobarography, pressure, sinus tarsi approach, time,
• MeSH
• biomechanika MeSH
• časové faktory MeSH
• chůze (způsob) fyziologie   MeSH
• chůze fyziologie   MeSH
• dislokovaná fraktura diagnostické zobrazování   chirurgie   MeSH
• dospělí MeSH
• fraktury kostí diagnostické zobrazování   chirurgie   MeSH
• hodnocení rizik MeSH
• index tělesné hmotnosti MeSH
• intraartikulární fraktury diagnostické zobrazování   chirurgie   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• neparametrická statistika MeSH
• patní kost zranění   chirurgie   MeSH
• plantární plocha MeSH
• poranění nohy (od hlezna dolů) diagnostické zobrazování   chirurgie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• skóre závažnosti úrazu MeSH
• tlak MeSH
• vnitřní fixace fraktury metody   MeSH
• výsledek terapie MeSH
• zatížení muskuloskeletálního systému fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

Injury of an artery has a significantly worse prognosis for the patient than a venous injury. Blunt injuries of lower limb digital arteries with the development of acute ischemia present a very rare phenomenon. A crush mechanism with a defect of the non-wetted surface of vessel's inner part and the development of subsequent thromboischemic lesion is essential for the development of ischemia. We report a blunt injury of the right lower limb in a patient after incorrect stepping with subsequent lesion of digital arteries and the development of acute acral ischemia of the right toes.

• Klíčová slova
• Closed injury, Ischemia, Trombolysis,
• MeSH
• angiografie MeSH
• dospělí MeSH
• ischemie diagnostické zobrazování   etiologie   MeSH
• lidé MeSH
• poranění cév komplikace   diagnostické zobrazování   MeSH
• poranění nohy (od hlezna dolů) komplikace   diagnostické zobrazování   MeSH
• prsty nohy krevní zásobení   diagnostické zobrazování   MeSH
• tupá poranění komplikace   diagnostické zobrazování   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The therapeutic applications of titanium-nickel (TiNi) shape memory clamps with optimized structural characteristics for fixation of small bone fragments in 64 patients are presented. Our fixative makes compressive stabilization possible and enables a patient to start rehabilitation very soon after surgery. The supporting splint immobilization never exceeded 12 days. Three aspects were studied: bone union, wound healing problems and histology. Non-union occurred in 4 patients treated with only one fixative. Two clamps implanted in non-parallel planes seem to be advisable to exclude the need for longer immobilization. Neither toxic manifestation nor episodes of an allergic reaction occurred. No suppuration appeared when a heat stimulus was supplied by using a contact resistance heater. Histological evaluation of the tissue covering the implants in 22 patients did not reveal any adverse reaction. Our study suggests that by using TiNi clamps in an appropriate way, satisfactory outcomes could be achieved with respect to both biofunctionality and biocompatibility.

• MeSH
• chirurgické nástroje * MeSH
• hojení fraktur fyziologie   MeSH
• interní fixátory MeSH
• kosti nohy (od hlezna dolů) zranění   chirurgie   MeSH
• lidé MeSH
• metakarpofalangeální kloub zranění   chirurgie   MeSH
• následné studie MeSH
• nikl * MeSH
• poranění nohy (od hlezna dolů) diagnostické zobrazování   chirurgie   MeSH
• poranění ruky diagnostické zobrazování   chirurgie   MeSH
• radiografie MeSH
• remodelace kosti fyziologie   MeSH
• slitiny * MeSH
• titan * MeSH
• tříštivé fraktury diagnostické zobrazování   patologie   chirurgie   MeSH
• vnitřní fixace fraktury škodlivé účinky   přístrojové vybavení   metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• nikl * MeSH
• slitiny * MeSH
• titan * MeSH
• titanium nickelide MeSH Prohlížeč