Dorsomedial Bridge Plating of Lisfranc Injuries

Injuries to the tarsometatarsal joints remain uncommon, with a reported incidence of 1 per 55,000 people per year. Lisfranc injuries make up a small percentage of all fractures, though the incidence appears to be increasing. Although the criteria for surgical intervention are well accepted, a significant controversy exists regarding surgical technique. This becomes increasingly cloudy as the debate moves from complex fractures to purely ligamentous injuries. Although pure ligamentous injuries have traditionally been fixed with Kirschner wires or screws transfixing the involved joints, a recent prospective, randomized study suggests that these injuries may be best treated by primary arthrodesis. The goal of any surgery addressing a Lisfranc injury is not only to restore the patient's anatomy, but also to preserve the involved joints. There are numerous studies implicating both heat and traumatic impact as sources of cellmediated chondrocyte death. Transarticular screw placement requires drilling across an intact cartilage layer that has already sustained traumatic insult. This ''second hit'' may exacerbate an already complicated problem, and, potentially, accelerate the posttraumatic arthritic process. Extra-articular bridge plate fixation offers a means of addressing these Lisfranc injuries without joint violation.