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Surgical Exposure of Lisfranc’s Fracture

- Two Incision Exposure:
    - prior to open exposure, a markedly displaced frx should be reduced and held in place w/ K wires;
    - 6-7 cm linear incision beginning 2 cm proximal to Lisfranc joint & extending distally over first intermetatarsal space;
           - avoid damage to dorsalis pedis artery and deep peroneal nerve;
    - if 3rd metatarsal is dislocated, make 2nd dorsal linear incision between the third and fourth metatarsals;
    - 1st and 2nd joint capsules are opened thru dorsal incisions, which allows exposure to the joint surfaces;
    - alterantive incisions:
           - dorsal incision over 2nd metatarsal (for fixation of 1st to 3rd rays);
           - lateral incision is made in 4th interspace;

- One Incision Exposure:
    - longitudinal incision centered over naivular and medial side of 3rd metatarsal;
    - dissect along the lateral border of the EHL, which should then reveal dorsalis pedis artery and deep peroneal nerve;
          - follow the neurovascular bundle to the 1-2 interspace;
          - cauterized the perforating artery between the 1-2 interspace;
    - the EHL and N/V bundle are retracted laterally, to expose the 1-2 interspace, and in contrast, the EHL and neurovascular bundle is retracted medially to expose the 3-4 articulation;
    - exposure 1-2 interspace, inspect articulations, remove bony fragments;
          - in some cases, there will be instability between the cuneiforms, which will require modification of the screw insertion strategy

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