Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table with the affected foot elevated and prepped under sterile conditions.

Anatomical surgical approach:  A dorsal longitudinal incision was made to access the metatarsophalangeal joints. Each toe was individually addressed through open reduction, repositioning them onto their correct proximal phalanx. Temporary Kirschner wire fixation was utilized to maintain alignment. The Lisfranc joint was stabilized with percutaneous pinning.

The surgeon noted the unusual nature of the homolateral toe dislocation, requiring meticulous open reduction for each digit. Given the severe soft tissue compromise and risk of vascular insufficiency, the patient was counseled regarding the potential for partial or complete toe loss, as well as possible skin necrosis.

Postoperative protocol:   Postoperatively, the patient was advised to maintain non-weight bearing status on the affected limb. A protective splint was applied, and close monitoring of vascular status was emphasized. Progressive weight bearing would be considered based on soft tissue healing and stability of the Lisfranc fixation.

Follow up:   Not specified.

Orthopaedic implants used:   Kirschner wires for toe fixation, percutaneous pins for Lisfranc stabilization.