AOFAS Midfoot Scale - PDF File
Sunday, 28 April 2013
Tracking Outcomes - AOFAS Midfoot Scale
In an effort to track outcomes for our patients we will be using the AOFAS midfoot scale. I have attached the AOFAS midfoot scoring sheet. If you are a patient it would be appreciated if you could fill out this form on your first and subsequent visits.
AOFAS Midfoot Scale - PDF File
AOFAS Midfoot Scale - PDF File
Thursday, 18 April 2013
Lisfranc Fusion Video
Although this linked video was produced specifically for hallux valgus surgery, the principles are the same and good surgical technique is demonstrated.
Wednesday, 17 April 2013
Ligamentous Lisfranc Injuries
Ligamentous Lisfranc Injuries are often associated with poor outcomes. I have attached pre and post operative x-rays of a Lisfranc fusion.
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| Pre-operative Bilateral Standing X-rays |
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| Post-operative AP |
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| Post-operative Lateral |
Tuesday, 16 April 2013
Lisfranc Injuries - Dr. Christopher Lu
Lisfranc injuries are rare. They account for 0.2% of all fractures. This works out to an incidence of 1 per 55,000 persons per year. In the Greater Toronto Area - we have a population of 5.5 million. Therefore there are approximately 100 Lisfranc injuries per year in the GTA. There are approximately 200 Orthopaedic Surgeons in the GTA. Therefore each surgeon on average, will see one Lisfranc injury every 2 years.
If you are reading this blog there is a good chance that either you or someone you know has a Lisfranc injury. Alternatively, you are probably an Orthopaedic Surgery Resident or Attending.
I have a sub-specialty interest in Lisfranc injuries and have created a regional centre of excellence for the treatment of patients with Lisfranc injuries. If you have a Lisfranc injury and happen to live in Canada simply have your Family Physician / Orthopaedic Surgeon fax a referral to our office. International patients are asked to contact our office for further information / pre-clearance.
Surgery is performed at Georgetown Hospital, which is located 30 minutes from Toronto Pearson Airport. Lisfranc fusion procedures are performed as a day surgery procedure. Operative time is approximately 70 minutes.
Preferred work up for patients would be: Bilateral standing x-rays and a CT of the affected foot.
Assuming that you are a non-smoker / non-diabetic there is an 80% chance that we can achieve an improved outcome with a Lisfranc fusion procedure. However, I am limited in that I cannot make your foot better than the uninjured side.
If you have a Lisfranc injury and are interested in reconstructive surgery please have your Family Physician / Sports Medicine Physician / Orthopaedic Surgeon refer you to:
Dr. Christopher Lu MBchB FRCSC
Assistant Clinical Professor (Adjunct) - McMaster University
Orthopaedic Foot and Ankle Surgeon
Unit 200 - 1A Princess Anne Drive
Georgetown, Ontario
Canada
L7G 4W4
Phone: 905-873-8883
Fax: 289-801-2239
Linkedin profile:
http://www.linkedin.com/in/chrisluortho
E-consult available via Champlain LHIN E-consult service (family physician needs to be registered with Champlain / Halton / Peel E-consult service).
E-consult
RateMD reviews:
https://www.ratemds.com/doctor-ratings/3570242/Dr-Christopher-Lu-Georgetown-ON.html
If you are reading this blog there is a good chance that either you or someone you know has a Lisfranc injury. Alternatively, you are probably an Orthopaedic Surgery Resident or Attending.
I have a sub-specialty interest in Lisfranc injuries and have created a regional centre of excellence for the treatment of patients with Lisfranc injuries. If you have a Lisfranc injury and happen to live in Canada simply have your Family Physician / Orthopaedic Surgeon fax a referral to our office. International patients are asked to contact our office for further information / pre-clearance.
Surgery is performed at Georgetown Hospital, which is located 30 minutes from Toronto Pearson Airport. Lisfranc fusion procedures are performed as a day surgery procedure. Operative time is approximately 70 minutes.
Preferred work up for patients would be: Bilateral standing x-rays and a CT of the affected foot.
Assuming that you are a non-smoker / non-diabetic there is an 80% chance that we can achieve an improved outcome with a Lisfranc fusion procedure. However, I am limited in that I cannot make your foot better than the uninjured side.
If you have a Lisfranc injury and are interested in reconstructive surgery please have your Family Physician / Sports Medicine Physician / Orthopaedic Surgeon refer you to:
Dr. Christopher Lu MBchB FRCSC
Assistant Clinical Professor (Adjunct) - McMaster University
Orthopaedic Foot and Ankle Surgeon
Unit 200 - 1A Princess Anne Drive
Georgetown, Ontario
Canada
L7G 4W4
Phone: 905-873-8883
Fax: 289-801-2239
Linkedin profile:
http://www.linkedin.com/in/chrisluortho
E-consult available via Champlain LHIN E-consult service (family physician needs to be registered with Champlain / Halton / Peel E-consult service).
E-consult
RateMD reviews:
https://www.ratemds.com/doctor-ratings/3570242/Dr-Christopher-Lu-Georgetown-ON.html
Monday, 15 April 2013
Saturday, 13 April 2013
Lisfranc ORIF vs. Fusion
A 2012 article comparing Lisfranc ORIF vs. Fusion.
Below I have also listed the other comparative studies that have been performed.
Lisfranc ORIF vs. Fusion 2012 - pdf
Lisfranc ORIF vs. Fusion 2009
Lisfranc ORIF vs. Fusion 2006
One advantage of fusion vs. ORIF is that the procedure no longer needs to be performed urgently. One caveat is the severity of the injury. Another caveat is that patients who wait greater than 1 year - seem to have a worse outcome. At present, the optimal time to perform surgery seems to be within 4 months of injury.
This is good for several reasons:
1) The patient can plan when they want to have the fusion. This gives the patient time to plan ahead in regards to work, school, child care, transportation and housing arrangements.
2) The patient and surgeon are convinced that they are dealing with a true lisfranc injury. If you have a simple metatarsal fracture this should heal within 6 to 12 weeks. However, if the pain does not get better in this time period, and you have separation at the lisfranc ligament, there is a possibility that you have a lisfranc injury. The recovery from any lisfranc procedure is a minimum of 6 months (typically 1 year), thus it is important to ensure you are dealing with a true lisfranc injury with the associated chronic pain before choosing surgical treatment.
3) Non-operative management has been exhausted.
4) Swelling in the foot and wound closure is no longer an issue.
5) You can take the time to find an Orthopaedic Surgeon who specializes in Foot and Ankle Surgery to perform your surgery. If you decide to proceed with a fusion procedure I would recommend that you find an Orthopaedic Surgeon who specializes in Foot and Ankle Surgery. The reason for this is that a Lisfranc fusion procedure is a surprisingly difficult operation to perform well. If you proceed with a Lisfranc fusion procedure please make sure you have adqeuate amounts of Vitamin D and Calcium in your diet - to ensure that the bones fuse well.
6) Based on the articles listed above and personal experience, lisfranc fusion patients tend to have consistently better results at short and mid term follow-up.
7) If a fusion procedure is successful - no further operations are required. With ORIF, it is often routine to remove the hardware. Also, if the ORIF is not successful, the next option is to proceed with hardware removal, followed by a fusion procedure. Unfortunately, at this point the patient is usually several years into their injury.
Medical Disclaimer
Below I have also listed the other comparative studies that have been performed.
Lisfranc ORIF vs. Fusion 2012 - pdf
Lisfranc ORIF vs. Fusion 2009
Lisfranc ORIF vs. Fusion 2006
One advantage of fusion vs. ORIF is that the procedure no longer needs to be performed urgently. One caveat is the severity of the injury. Another caveat is that patients who wait greater than 1 year - seem to have a worse outcome. At present, the optimal time to perform surgery seems to be within 4 months of injury.
This is good for several reasons:
1) The patient can plan when they want to have the fusion. This gives the patient time to plan ahead in regards to work, school, child care, transportation and housing arrangements.
2) The patient and surgeon are convinced that they are dealing with a true lisfranc injury. If you have a simple metatarsal fracture this should heal within 6 to 12 weeks. However, if the pain does not get better in this time period, and you have separation at the lisfranc ligament, there is a possibility that you have a lisfranc injury. The recovery from any lisfranc procedure is a minimum of 6 months (typically 1 year), thus it is important to ensure you are dealing with a true lisfranc injury with the associated chronic pain before choosing surgical treatment.
3) Non-operative management has been exhausted.
4) Swelling in the foot and wound closure is no longer an issue.
5) You can take the time to find an Orthopaedic Surgeon who specializes in Foot and Ankle Surgery to perform your surgery. If you decide to proceed with a fusion procedure I would recommend that you find an Orthopaedic Surgeon who specializes in Foot and Ankle Surgery. The reason for this is that a Lisfranc fusion procedure is a surprisingly difficult operation to perform well. If you proceed with a Lisfranc fusion procedure please make sure you have adqeuate amounts of Vitamin D and Calcium in your diet - to ensure that the bones fuse well.
6) Based on the articles listed above and personal experience, lisfranc fusion patients tend to have consistently better results at short and mid term follow-up.
7) If a fusion procedure is successful - no further operations are required. With ORIF, it is often routine to remove the hardware. Also, if the ORIF is not successful, the next option is to proceed with hardware removal, followed by a fusion procedure. Unfortunately, at this point the patient is usually several years into their injury.
Medical Disclaimer
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