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Spanning Fixation of Lisfranc Joint Injuries
The management of midfoot injuries has evolved in the past few decades. Surgeons have increasingly recognized the need for precise restoration of midfoot alignment. The midfoot joints are most important for stability, not flexibility; thus, transarticular screws work well. However, in some patients the midfoot bones are too comminuted to support a transarticular screw, and a dorsal spanning plate may be more useful. Furthermore, use of a dorsal plate does not require creation of a large hole through the articular cartilage, and it will allow some motion of the joint, so in theory, dorsal plates may improve outcomes and reduce aching in the midfoot at final follow-up. Although stability may be similar with either dorsal spanning plate fixation or transarticular screw fixation, dorsal plates offer greater construct flexibility, which may make it more physiologic. It may be that allowing a small amount of motion and minimizing cartilage damage improves results. This chapter details the indications, contraindications, surgical steps, and postoperative protocol for dorsal spanning plate fixation of midfoot fractures.