Midfoot Injuries (Lisfranc Injuries): Lisfranc Reduction With a Plate and Screws

Midfoot Injuries (Lisfranc Injuries): Lisfranc Reduction With a Plate and Screws

This video will provide a cadaveric demonstration of the surgical treatment of a Lisfranc complex injury utilizing a plate and screws to stabilize the injury during healing. In review, the anatomy of the Lisfranc complex includes 4 bones: the medial cuneiform, the middle cuneiform, the first metatarsal base, and the second metatarsal base. The complex also includes several ligaments, including those pictured on the top of the foot.

When a Lisfranc complex injury occurs, damage to these ligaments and widening is seen between the bones. Breaks in the nearby bones may also occur. A plate and screws is 1 option to bring the joints back into normal alignment while the soft tissue and any potential fractured bones heal. Here is a left foot. The surgeon will make an incision to the top of the foot, just overlying the Lisfranc complex.

The complex is now exposed, and retractors hold crucial soft-tissue structures outside the surgical field. The torn complex is shown along with instability, or unwanted movement in the structure. A surgical bone clamp will hold the complex in alignment, and a contoured plate will be brought into the incision and placed over the necessary structures. Temporary ball-tipped wires will be placed to hold the plate in alignment on the bone.

A drill guide and bit will be used to make a hole in the medial cuneiform bone. The hole is measured with a depth gauge which will help the surgeon identify the proper-sized screw for the plate. The surgeon then places the screw in place. Another type of screw, called a locking screw, will be used in the next hole. A different drill guide is used for these screws that allow the surgeon to measure the depth of the hole from the drill guide.

Locking screws have threads that lock into the plate and may be used in combination with nonlocking screws to provide the best compression of the injury. Along with the compression offered by the screws, plates like the one shown provide additional stiff and stable compression to the joints while the complex heals. The proper-sized locking screw is then placed. The surgeon will remove the wires and repeat these steps for the final 2 screws.

The movement previously seen in the complex is now stabilized. The incision will be closed, and the surgery is now complete.