The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
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Subtle Lisfranc instability is typically a low-energy, twisting, axial-loading injury. The present study evaluated the operative treatment of subtle Lisfranc injuries after nonoperative failure. The data from consecutive patients with subtle Lisfranc instabilities were reviewed. ⋯ The mean AOFAS score after nonoperative treatment (75.3 ± 15.8) was lower than the mean postoperative AOFAS score (92.3 ± 8.43; p < .0001). Of the 9 feet stabilized with dual screws, 7 (77.78%) required screw removal during the observation period. Subtle Lisfranc injuries failing nonoperative treatment were successfully stabilized using either a dual screw or suture button technique.
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Ankle arthroscopic procedures offer less postoperative morbidity with faster healing times than open surgical procedures but still have associated risks. Complication rates as high as 17% have been reported. One of the most commonly reported complications is iatrogenic damage to the superficial peroneal nerve, which can result in numbness, tingling, or painful neuralgia. ⋯ Through our dissections, we found that most ankles have 2 nerve branches at the level of the ankle joint (Takao type II) and that the location of the superficial peroneal nerve branches at the ankle correlated directly with the ankle width. Additionally, 68% of specimens contained a nerve branch located in zone 1, where the anterolateral portal is placed, and 12% had a branch in zone 5, the location of the anteromedial portal site. The results of the present study have confirmed the wide variation in nerve location at the level of the ankle joint and serve to highlight the need for extreme caution during surgical procedures at the ankle.