1. 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

2. Case description
21-year-old man
Motorcycle accident

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

4. 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

5. Internal fixation— intraoperative images

6. 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. 7.5-year follow-up

8. 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 Nov;90(11):1499–1506.
Rammelt et al. J Bone Joint Surg Br. 2008;90:1499–1506