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- Discussion:
    - impediments to reduction:
         - incarcerated bony fragments which remain attached to lisfranc ligament;
         - entrapped anterior tibial tendon may occur in the case of a laterally dislocated first metatarsal (homolateral);
    - key to reduction:
         - firm opposition of the lateral border of the medial cuneiform to the second metatarsal which allows healing of lisfranc's ligament;
    - first metatarsalcuneiform joint:
         - is reduced & stabilized first;
         - reduction of this articulation often results in reduction of the 2nd metatarsal cuneiform articulation;
         - lateral borders of 1st metatarsal base & medial cuneiform are aligned & 2nd metatarsal base is firmly apposed to lateral border of first cuneiform;
               - reduction of frx dislocation of 2nd metatarsal is essential;
    - initial reduction can be held together w/ K wires;
         - w/ divergent & homolateral types of injury, use 2 transfixion wires;
         - one through 5th metatarsal base into cuboid & one through 1st metatarsal into first cuneiform;
         - ensure that frx is reduced in saggital plane by matching dorsal margins of these joint surfaces