Surgical Discussion

Patient positioning:  Supine position with a bump under the ipsilateral hip to allow for easier access to the dorsal aspect of the foot.

Anatomical surgical approach:  A dorsal longitudinal incision was made over the tarsometatarsal joints. Subcutaneous tissues were carefully dissected to expose the extensor tendons, which were retracted to provide access to the Lisfranc joint complex. The joint capsule was incised longitudinally, and careful reduction of the dislocated joints was achieved under direct visualization.

Due to the patient's status as a smoker and brittle diabetic, a more conservative fixation approach was chosen, avoiding extensive soft tissue dissection. K-wires were used for temporary stabilization, and plates were applied to reinforce the reduction. The decision not to perform a Castro slide was based on concerns regarding wound healing and potential complications associated with her comorbidities.

Postoperative protocol:   Postoperatively, the patient was placed in a non-weight-bearing cast for 8 weeks. Transition to partial weight-bearing in a controlled ankle motion (CAM) boot was planned after removal of K-wires, with gradual progression to full weight-bearing as tolerated.

Follow up:   Not specified.

Orthopaedic implants used:   K-wires, plates for second metatarsal to middle cuneiform and third metatarsal to lateral cuneiform, cannulated screw from first metatarsal to medial cuneiform.