Subtle, or ligamentous, Lisfranc injuries occur following low-energy trauma to the midfoot and can be debilitating. Since they are ligamentous,... [more]
On the lateral weight-bearing radiograph, the talar component position was determined by evaluating the angle formed between a line drawn along the inferior horizontal surface of the talar component and a line drawn parallel to the floor (angle C).
Relationship between the probability of belonging to the Lisfranc injury group and the ratio between second metatarsal length and overall foot length. The 95% confidence interval of the predicted probability distribution is depicted by shading.
Anteroposterior radiograph demonstrating the anteroposterior tibiotalar angle as measured preoperatively.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram31 of this study is shown.
The typical intraoperative image provided by the Iso-C3D fluoroscope.
Gel photographs showing genotyping of three retrieved allograft representative cases (for overall results, see Appendix). Total DNA from retrieved allograft cartilage (A) was compared with recipient (R) and donor (D) constitutional DNA by PCR analysis at five short tandem repeat sequences (CD4, VWA, FES, TPOX, and P53). PCR products were run on acrylamide gels. Case 1: complete matching between allograft and recipient DNA (A = R); Case 13: complete matching between allograft and donor DNA (A = D); and Case 15: allograft partial matching with both recipient and donor DNA, indicating a mixed population of recipient and donor cells in the allograft (A = mixed). Allele length was estimated by a side-by-side comparison with allelic ladders made up from a mixture of known alleles and is expressed as the number of repeats27 as indicated beside gel images.
Example of articular step-off of >2 mm postoperatively as seen on sagittal (left image) and coronal (right image) CT scans. This patient had a malreduction of the medial malleolus.
Illustration of the technical procedures. 1. Wound debridement and skin defatting: radical excision of nonviable tissue and fascia flap transfer to cover bone or tendon exposure when necessary. The degloved skin is defatted with use of scalpels (replaced frequently). The skin should be kept on tension during this process to facilitate defatting. 2. Skin graft application: multiple small 1-cm incisions (black arrow) are made to drain any seroma or hematoma from the recipient bed. The skin graft is further stabilized with interrupted sutures (white arrow) around the foot after it is replanted. 3. Bolster dressing: gauze is processed into small balls and stuffed around the irregular regions topographically, including the ankle, the medial plantar area, and the metatarsophalangeal joints, to further secure the skin graft. 4. Padded dressing: cotton pads are applied around the foot to create a bulky dressing. 5. The limb is immobilized with a posterior plaster splint for seven to ten days postoperatively.
The tendon’s hierarchical structure begins at the molecular level with tropocollagen1. Approximately five tropocollagen molecules form a microfibril, which then aggregate to create a subfibril1. Several subfibrils form a single fibril. Multiple fibrils form a tendon fascicle, and fascicles, separated by the endotenon, join to form the macroscopic tendon1. Tendon fibroblasts, or tenocytes, are found on collagen fibers allowing for the regulation of the extracellular environment in response to chemical and mechanical cues. (Reproduced, with permission of Elsevier, from: Silver FH, Freeman JW, Seehra GP. Collagen self-assembly and the development of tendon mechanical properties. J. Biomech. 2003 Oct;36(10):1529-33, Copyright 2003; and Wang JH. Mechanobiology of tendon. J Biomech. 2006;39(9):1563-82, Copyright 2006.)
A table showing demographic data for the four hindfoot alignment groups
Figures showing preoperative and postoperative clinical photographs and radiographs of feet that were treated with a distal chevron osteotomy and a distal soft-tissue release through either a dorsal first web-space approach or a medial transarticular approach
Figures showing the surgical field of representative cases and a dendrogram obtained by hierarchical clustering of six allograft samples and eight defined control cell types, tables showing the summary of primer sequences and Amplicon size for real-time reverse transcription PCR (RT-PCR) analysis, allograft genotyping, relative mRNA expression of different markers in cartilage allograft samples and in controls, and ICRS-I subscores for the seventeen analyzed cases, and text explaining the surgical technique, genotyping, likelihood ratio, and cluster analysis used in this study