The Diagnosis and Initial Management of Injury to LisfrancÃ¢Â€Â™s Joints in the Primary Care Setting in South-Eastern Ontario: How are we Doing?
|Mayich DJ1*, Charnish M2, Holden R3, Grant H4 and Harrison MM1|
|1Division of Orthopaedic Surgery, Dalhousie Medicine, New Brunswick Campus, Saint John, New Brunswick, Canada|
|2Division of Emergency Medicine, Toronto East General Hospital, Toronto, Ontario, Canada|
|3Psychology Department, Queen's University, Kingston, Canada|
|4Biostatistician, Human Mobility Research Center, Queen's University, Kingston, Canada|
|Corresponding Author :||D Joshua Mayich
MSc MD FRCSC, Division of Orthopaedic Surgery
Suite 200, 555 Summerset St, Saint John
New Brunswick, Canada, E2K-4X2
Tel: (506) 652-5535 Fax: (506) 652-5597
E-mail: [email protected]
|Received September 01, 2014; Accepted October 22, 2014; Published October 25, 2014|
|Citation: Mayich DJ, Charnish M, Holden R, Grant H, Harrison MM (2014) The Diagnosis and Initial Management of Injury to Lisfranc’s Joints in the Primary Care Setting in South-Eastern Ontario: How are we Doing?. Clin Res Foot Ankle 2: 156. doi:10.4172/2329-910X.1000156|
|Copyright: © 2014 Mayich J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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Objectives: Subtle Injuries to the Lisfranc's joint complex (or LFIs) can be difficult to diagnose on initial presentation to the primary care physician (or PCP). Significant research has gone into subspecialty imaging and operative management of LFIs. Little research, unfortunately, has gone into how PCPs, who are typically must initially suspect, and ultimately diagnose LFIs initially, perform when seeing cases typical of LFIs.
Methods: A survey that assessed the diagnostic accuracy and management of LFIs in PCPs in Ontario was designed and validated. A final survey was circulated, via mail, to PCPs in southeastern Ontario. 189 of the 851 (22.2%) contacted PCPs responded to the survey. Demographic data was collected and compared to available information to ensure a representative sample.
Results: With reference to subtle LFIs, A misdiagnosis of "soft tissue sprain" was made 35% of the time, while only 17% of respondents were able to correctly identify the unstable nature of the injury. 54% of responding PCPs indicated follow-up with an orthopaedic surgeon within the recommended two weeks.
Conclusions: A directed educational intervention aimed at teaching PCPs in Ontario the principles for diagnosis and management of LFIs is indicated. These interventions may potentially help in increasing understanding and increasing the level of clinical suspicion when presented with the clinical scenario that can be associated with LFIs.