Surgical Discussion

Patient positioning:  Supine positioning on the operating table with the injured foot elevated and prepared for sterile field access.

Anatomical surgical approach:  A dual approach was utilized: a dorsal incision for direct access to the Lisfranc complex and inter-cuneiform space, and a lateral incision to address the lateral column crush injury. The dorsal approach allowed for visualization and stabilization of the inter-cuneiform instability and tarso-metatarsal dislocations, while the lateral approach facilitated reduction and fixation of the cuboid fracture and calcaneo-cuboid subluxation.

The surgeon noted the importance of addressing both medial and lateral column injuries to prevent future deformities. The medial column was rigidly fixed to ensure stability, while the lateral column required flexible fixation due to the complex nature of the injury. The use of a spanning plate effectively maintained lateral column length without relying on ligamentotaxis, which was compromised in this case.

Postoperative protocol:   Postoperative rehabilitation included non-weight bearing on the affected limb for six weeks, followed by progressive weight-bearing as tolerated. Physical therapy focused on range of motion exercises and gradual strengthening.

Follow up:   Not specified.

Orthopaedic implants used:   Spanning plate for lateral column stabilization, screws for rigid fixation of the medial column, Kirschner wires for temporary stabilization.