- Discussion:
-
impediments to reduction:
- incarcerated bony fragments which remain attached to
lisfranc ligament;
- entrapped
anterior tibial tendon may occur in the case of a laterally
dislocated first metatarsal (homolateral);
-
key to reduction:
- firm opposition of the lateral border of the medial cuneiform to the
second metatarsal which allows healing of
lisfranc's ligament;
-
first metatarsalcuneiform joint:
- is reduced & stabilized first;
- reduction of this articulation often results in reduction of the 2nd metatarsal
cuneiform articulation;
- lateral borders of 1st metatarsal base & medial cuneiform are aligned & 2nd
metatarsal base is firmly apposed to lateral border of first cuneiform;
- reduction of frx dislocation of 2nd metatarsal is essential;
- initial reduction can be held together w/ K wires;
- w/ divergent & homolateral types of injury, use 2 transfixion wires;
- one thru 5th metatarsal base into cuboid & one thru 1st metatarsal
into first cuneiform;
- ensure that frx is reduced in saggital plane by matching dorsal margins of
these joint surfaces;
