ABSTRACT
CONTENTS I. Tarsometatarsal (TMT) (Lisfranc) Injuries ....................................................................... 118
A. Introduction............................................................................................................... 118
B. History....................................................................................................................... 118
C. Anatomy.................................................................................................................... 118
D. Biomechanics ............................................................................................................. 121
E. Mechanism of Injury ................................................................................................. 122
F. Classification.............................................................................................................. 124
G. Diagnosis ................................................................................................................... 126
H. Treatment .................................................................................................................. 129
1. Principles ............................................................................................................. 129
2. Timing of Surgery ............................................................................................... 130
3. Closed Reduction and Casting ............................................................................ 131
4. Closed Reduction and Percutaneous Fixation .................................................... 131
5. External Fixation ................................................................................................ 132
6. Open Reduction and Internal Fixation ............................................................... 132
7. Extensile Dorsomedial Approach to the Midfoot ............................................... 132
I. Postoperative Care..................................................................................................... 135
J. Prognosis ................................................................................................................... 136
K. Midfoot Sprains in Athletes....................................................................................... 140
L. Salvage Procedures .................................................................................................... 143
M. Complications............................................................................................................ 143
1. Devascularization................................................................................................ 143
2. Skin Compromise................................................................................................ 145
3. Other Complications ........................................................................................... 145 II. Midfoot Fractures ............................................................................................................. 145
A. Introduction............................................................................................................... 145
B. Anatomy.................................................................................................................... 145
C. Navicular Fractures ................................................................................................... 146
1. Classification and Mechanism of Injury.............................................................. 146
2. Diagnosis............................................................................................................. 148
3. Treatment............................................................................................................ 150 III. Conclusion ........................................................................................................................ 159 References .................................................................................................................................. 159
I. TARSOMETATARSAL (TMT) (LISFRANC) INJURIES
A. Introduction
Injuries to the TMT, or Lisfranc, joint complex occur in widely varying patterns and degrees of severity. They may be widely displaced derangements of the foot or may be among the subtlest and most easily overlooked of foot injuries. Yet the critical role that stability of this complex plays in the biomechanics of the foot may cause even seemingly innocuous injuries to lead to pronounced longterm disability if not properly treated [1-4]. Treatment of these injuries has evolved significantly in recent years, with new emphasis on the importance of anatomic reduction and fixation.
