Medial Plate Fixation of Lisfranc Injuries

This article describes a method of open reduction and internal fixation of tarsometatarsal injuries using a medial-positioned plate and indirect reduction technique. Additional plates may be used dorsally to span the comminuted fractures at the bases of the lesser metatarsals or to function as spring-plates. This technique achieves rapid, reliable reduction of the deformity while avoiding damaging transarticular screw fixation. Before 2005, the senior author used traditional open reduction with 3.5-mm screw fixation of the tarsometatarsal articulations. Like that of other investigators, this experience showed mixed functional outcomes with frequent findings of degenerative radiographic changes, despite anatomic or near-anatomic reduction of the deformity. Medial plating has been described earlier as a technique for correcting an abduction midfoot deformity at the time of arthrodesis. The senior author has also used this medial plating technique for arthrodesis of midfoot joints, but since 2005, medial plating has also been the primary method of internal fixation for acute Lisfranc traumatic injuries without arthrodesis. We describe the method of the reduction and plate introduction, the protocol for recovery, and an initial overview of the results.