Dorsomedial Approach to Lisfranc’s JointThis approach is used for the treatment of pathology of Lisfranc’s joint. Generally, two incisions are made for severe midfoot fractures. Single incisions may be used for treating isolated dislocations of the first ray at Lisfranc’s joint or other conditions such as arthritis or fractures.
The midfoot contains a complex array of bony structures that ensure stability for the medial side of the midfoot and flexibility for the lateral side of the midfoot. For this reason, implants used to treat fractures in this area are more rigid on the medial than the lateral side. In turn, this means that surgical approaches are usually more extensive on the medial than lateral side.
Position of the Patient
Place the patient supine on the operating room table (see Fig. 7-1). Place a sandbag beneath the buttock of the affected side to counteract the natural external rotation of the leg and put the foot into a neutral position. After exsanguination, apply a tourniquet to the mid-thigh.
Landmarks and Incisions
It is very difficult to palpate the medial part of Lisfranc’s joint, therefore other bony anatomy must be used to locate it. Palpating the prominent base of the first metatarsal is usually possible, but frequently image intensification is necessary to identify the area. Make a 2- to 4-cm longitudinal incision directly over the area to be exposed (Fig. 30-1). The incision should be centered over the joint between the first metatarsal and the medial cuneiform.
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