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Monday, June 17, 2013

New technology for Lisfranc injuries and fusions

 
I had my 5 week post lisfranc surgery appointment last Friday and my surgeon said my healing couldn’t be more perfect! Together we looked at the 3 x-rays he had taken of my foot, and then he showed me the before surgery and after surgery x-rays plus a side view.  I commented that I had done some internet research on the titanium  plate he drilled into my foot and discovered it is new “state of the art” technology.  He smiled and said yes it is!  I mentioned to him that I was writing a blog, so he took pictures of my x-rays so that I could post them in my lisfranc blog:
    

                                      This is before surgery

Note the space between my first 2 metatarsals and how the metatarsal joints are out of alignment.

         This is 5 weeks following lisfranc open reduction surgery

Note the placement of the new titanium plate which corrected not only the space between my first two metatarsals, but aligned my joints once again.
 
 
 

This is a side view which shows how the plate is screwed into my metatarsals and cuneiform joints

 
 
 
 

This new titanium plate came on the market in 2012.  It cuts down on joint damage and  I won’t have to have additional surgery to have it removed.  It has now become a permanent part of me.  And the good news is that it is only 1.4mm thick and won’t set off metal detectors at the airport!  

 
I am posting the description of the new Lisfranc plates which I copied from Arthrex’s website.   If you would like more detailed information about the surgical procedure, check out this link:
 
 
under surgical technique guides click on “Lisfranc Reduction for Injuries and Fusions using Lisfranc Plates
 
 
 
 
“Lisfranc Plates offer multiple solutions and are easily contoured to patient’s needs
The new Lisfranc Plates were designed to provide fixation for acute Lisfranc injuries and fusions of the tarsal-metatarsal joints. The unique design allows for compression along the Lisfranc ligament and allows the surgeon to visualize the healing process during recovery. These plates come in three different sizes with both left and right plates to fit any patient and are contoured to fit the Lisfranc anatomy at only 1.4 mm thick. 

  • •  Allows visualization of the Lisfranc joint during healing process 
  • •  Compresses along the Lisfranc ligament—along the line of injury 
  • •  Eliminates the joint damage that may occur with the use of screws and guide wires 
  • •  Bridge-plating preserves the joint surfaces and results in larger surface area for bony fusion 
  • •  1.4 mm maximum thickness, provides minimal prominence and low profile contouring 
  • •  Contoured to fit the1st/2nd metatarsal—cuneiform joints 
  • •  Allows room for normal interfrag screw placement”

    (Taken from Arthrex’s website) https://www.arthrex.com/foot-ankle/lisfranc-plates

    I was also given permission from my surgeon to start partial weight bearing after only 5 weeks, which is a lot earlier than what other lisfranc surgeons are recommending to their patients.  I am sure it is because of these new plates! 

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When I was told I had a lisfranc fracture and would need surgery involving 6 weeks on non weight bearing inactivity, I admit I went numb.  I couldn’t comprehend what it would be like to sit around for 6 whole weeks!  After the initial shock, I decided I had to have a plan in place that would make me as independent as possible, for the next couple of months.  I thought I should share my lisfranc recovery survival ideas:

1.  Pick a place in your home where you have a bedroom and easy access to a bathroom with a shower.  If possible have a small refrigerator near by for water and ice packs/ice.  A TV with a blu ray player can ease boredom.

We have a multi level home and I decided to move down to our lower level where we usually entertain.  This space has a small kitchen, bathroom, shower, guest room,  and TV.  It was set up perfectly for my temporary mini apartment.  We decided to have a TV/Satellite and Blu Ray DVD player installed in the bedroom since the first 2 weeks I would most likely be in bed.

2.  Assemble ways to mobilate on one foot.

I have used 4 different kinds of “transportation.”  A walker, (without wheels) a wheelchair, crutches and a knee scooter.

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After trying out all 4 devices, the knee scooter has quickly became my favorite.  I like it because It doesn’t hurt my arms like the crutches and the walker, and it  is completely independent (unlike a wheel chair that my husband has to push) and I can move around my space easily.  It also feels “safe” and my foot feels very protected.  A basket on the front is a real plus and has quickly become my “purse” and a way to haul things from room to room.

3.  Set up the bathroom you will be using to accommodate standing on one leg. 

I started with the toilet.  I knew I couldn’t stand up from a seated position using only one leg so I found this toilet seat riser in a medical device store:

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Having the arms on the device is helpful, especially at first when fatigue from surgery is the greatest.

Next came the problem of how to shower and still keep my cas/splint dry.  So I bought “the giant condom.”  ImageThe rubber piece fits snug against your thigh and your cast stays completely dry.

A friend of mine gave me a stool to sit on while showering.  It doubles as the “chair” I use to put on make-up and dry my hair while siting in front of the bathroom mirror.

ImageI found a lot of the shower stools sold are pretty low and the height of this one is much easier when trying to stand back up on one leg.

My father came over and replaced the shower head with a hand held shower.  This was essential since it allowed me to move the water where I needed it and not have to move my body.

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4. Have plenty of ice, ice packs and instant cold available.  

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A friend of mine brought this over to me during my 3rd week of recovery.  I wish I had known about the air cast Cryo/cuff earlier!  I have been using it everyday since!  All you do is fill it with water and ice in the morning and it keeps cool all day!

5. Learn to say “yes” to friends who offer to help.

More on this tomorrow…..

Short Outing during LisFranc recovery

Since my surgeon has cleared me for short outings, my husband and I decided to attend a dear friend’s surprise birthday party today.One of the challenges of not being able to walk stairs in our multi level home is how to transport me from our lower level up to our driveway.  My husband devised a plan where I would maneuver onto his John Deere tractor by climbing on board from my knee scooter.  I then sit in the drivers seat with my legs spread, dangling my injured right foot over the side.  My husband, standing in-between my legs (with his butt in my face) operates the steering wheel, speed and direction.

I had a girlfriend be the guinea pig on the first attempt, while her husband shouted for my husband to get his butt out of his wife’s face.   We all laughed so hard, I thought it would never work, but it has been HUGE success.

I have to say, the first few times were very scary and I was convinced we would topple over and my foot would be re-injured.  But now, I look forward to my rare outings and the ride on the tractor. I am working on getting a picture so that you can see how we manage the John Deere transportation.

So today I took my tractor ride and my husband loaded my knee scooter into the trunk.  We arrived at the restaurant and I scootered in.  Immediately I felt very conspicuous and in the way.  People kept bumping into my injured foot and I was glad to have my bedazzled cast on my foot.

The party was fun, but I was shocked how tired out I became.  Eventually I sat down with my foot resting on my knee scooter.  But after a while, even that was painful.  I knew it was time to go home, ice and elevate.

It was wonderful to get out and see how beautiful the landscape has become this spring, even if the view is only from the window in the back seat of our car.

I am surprised, though, how cozy it is to be back in my chair with my foot in an iced air cast while it is elevated on two king sized pillows.  It has been an exhausting, but fun day.

I am now 3 weeks post surgery and have been curious about the plate my surgeon put into my foot since most of the lisfranc surgery pictures on the web didn’t look at all like mine. Most of the pictures  I could find were of various horizontal plates and elongated screws placed at different angles.  I didn’t find any pictures with a square plate like mine. I also noted that  several lisfranc surgery pictures showed more than one incision on top of the foot.

Yesterday I found a manufacturer of the square plates and discovered this is a newer concept in lisfranc surgery.  Here is the the website in case you want to check it out:

https://www.arthrex.com/foot-ankle/lisfranc-plates

I have only one incision on top of my foot and the plate my surgeon inserted will never have to be removed, so there will be no need for a second operation. I am very fortunate to not only have found my surgeon, but that he is on the cutting edge of lisfranc surgery.

My husband and I arrived early as we had heard my surgeon is typically way ahead of schedule.  The dear friend who helped us get an appointment with my surgeon had left a gift bag for me with my nurse.  So I already felt spoiled and loved.

I was taken back to a room and changed into a heated gown and was told to lie on the bed which had heated blankets. I felt like I was at a spa!  My nurse was fabulous.  She came in and told me she would be my best friend.  I told her I was concerned about how painful the surgery was going to be and she told me not to worry since she came packing.  She asked me what my favorite cocktail was and I told her a Belvedere martini straight up, a twist a couple of olives and extra dirty.  And she said ‘coming right up!”  And not only could I have 1 martinis she would give me 2.  I said I can only drink one and she said in this room, I could have 2.

The anesthesiologist  came in the room to discuss what he was going to do.  He had me write on the foot that was going to be operated on and I drew a smiley face.  I told him my surgeon said I could watch the surgery and he laughed and said, it wasn’t like having a baby where they have mirrors on the ceilings and that if I were to watch all I would be able to see was my surgeons head. He then told me I couldn’t watch anyway since I was going to be put under general anesthesia. Suddenly my wonderful nurse who was putting  a needle in my hand for my IV ran round to the right side of the bed and asked me to hold her hand and squeeze.  As I did and I felt the worst pain (level 9) since this whole thing started.

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My anesthesiologist was finding the nerves in my foot so that he could do a nerve block.  I didn’t cry out, but I did tell him he was mean (must of been the 2 martinis talking) and he said that I would be very happy with him after the surgery was over.  Nerve blocks can last up to 24 hours and really help with immediate pain following this type of surgery.  (I am so glad I had one!!!)

After Dr. Jekel was done with me, my surgeon came in the room and drew on my foot and assured me that all was well. Since my surgeon had already done 2 operations before me (and it was only 7:00am!) I offered to buy him a cup of coffee to make sure he was alert.  (again the martinis were talking) and he laughed.  I hate to think what else I might have said that I don’t remember!!!

Next I was wheeled down to the frigid operating room.  I reluctantly left my heated bed as I was asked to transfer myself to the skinny cold operating table.  I remember looking up at the white light fixture that looked like a giant spider with 8 legs.  As my arms were being strapped down I said to no one in general, that I was claustrophobic.  I told my nurse that I felt like I had been abducted by aliens and that they were going to do experiments on me.

When I woke up from surgery I was shown this picture of the operation:

lisfranc surgery

lisfranc surgery

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