Case for small group discussion Lisfranc injury Case for small group discussion AOTrauma—Foot & Ankle Module 6: Soft-tissue trauma Stefan Rammelt and Hans Zwipp, DE

Case description 21-year-old man Motorcycle accident

Soft-tissue status Increasing pain despite rest, ice, and elevation Increasing swelling over time (decreasing skin wrinkling) Obvious deformity Management options? Concerns?

Options for compartment release EHB DP EHL Discuss how many compartments to decompress, options for skin closure DP: Dorsalis pedis artery EHB: Extensor hallucis brevis tendon EHL: Extensor hallucis longus tendon

Internal fixation— intraoperative images

Postoperative protocol External fixation removed after 1 week (soft-tissue consolidation) K-wires removed after 6 weeks and graduated weight bearing starting at 8 weeks

7.5-year follow-up

Rammelt et al. J Bone Joint Surg Br. 2008;90:1499–1506 Take-home messages Immediate reduction and release of compartment through the same approach(es) Anatomical reduction is key to success Temporary fixation of 6–8 weeks is sufficient K-wires are adequate for fixation Alternatively consider screws and/or plates Residual clawing of the toes despite compartment release—vulnerable intrinsic muscles References: Rammelt S, Schneiders W, Schikore H, et al. Primary open reduction and fixation compared with delayed corrective arthrodesis in the treatment of tarsometatarsal (Lisfranc) fracture dislocation. J Bone Joint Surg Br. 2008 Nov;90(11):1499–1506. Rammelt et al. J Bone Joint Surg Br. 2008;90:1499–1506