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Răzvan Codrin Bandac 1 1 Grigore T. Mechanisms of injury are direct and indirect, including traffic accidents and sports. Clinical signs and symptoms are: midfoot pain, inability to bear weight, leg deformity and swelling, and plantar ecchymosis.

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Pedal artery or deep peroneal nerve may be compromised and the compartment syndrome may occur. Radiographic incidences reveal changes and dislocations in tarsometatarsal interlining.

Stress radiographs are helpful in unstable lesions. CT is used for diagnosis and preoperative planning. Lisfranc injury classifications can not determine the treatment or suggest prognosis.

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Medial and middle columns are fixed with 3. Postoperative care includes early mobilization, progressive weight-bearing, and osteosynthesis material removal. Primary tarsometatarsal arthrodesis is an alternative in lesions with severe joint damage.

Immediate complications are common, including neurovascular injury and compartment syndrome, and late complications are posttraumatic midfoot arthrosis, algoneurodistrofic syndrome, chronic foot pain, implant deterioration.

Patients require a long rehabilitation period.

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The incidence of posttraumatic arthritis is high, due to damaged articular surfaces, comminuted fractures, or due to side movements, results of unstable osteosynthesis.

Key words: Lisfranc joint complex, tarso-metatarsal dislocation, internal fixation, midfoot osteoarthritis. This term is used today to describe a Aspen pierdere în greutate baton rouge la spectrum of traumatic lesions to this region of the foot.

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Specialists concern for midfoot trauma is generally quite limited, inevitably leading to a inadequate knowledge and treatment of these lesions. Thus, Di Giovanni [1] noted a marked increase in the incidence of foot injuries due to increased frequency and severity of road accidents, and also more associated multiorgan injuries in polytrauma.

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This often puts in difficult situations the medical team, which has to act quickly in chosing the therapeutic maneuvers needed to maintain vital functions, and minimizing the treatment of leg trauma. Further course is burdened by severe pain and severe homolateral leg dysfunctions [3,4], with a psycho-socio-economic impact on the quality of life stronger than with any other injury.

Also, the widespread practice of collision sports, such as rugby, American [5,6] or even European football has led in recent decades to an increase in the incidence of midfood injuries, from simple, classified as midfoot sprains with different degrees of severity, to complex midfood Aspen pierdere în greutate baton rouge la dislocations and fracturedislocationposing serious diagnositic and treatment problems.

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Heckmann and colleagues explain the need for an as accurate orthopedic or surgical treatment as posible for ensuring perfect alignment of the injured structures, given the extremely complex biomechanics of the foot that does not allow imperfections [7,8]. Strict observance of the therapeutic principles gives satisfactory results, reducing the immediate circulatory disorders, skin necrosisbut also late arthritis, stiffness, vicious calluses complication rate [9,10].

Chapman and colleagues provide an important contribution by presenting detailed notions of biomechanics of the foot for each traumatic areas [5], and related to the pathophysiologic mechanisms of injury. These are corroborated with modern imaging methods for obtaining more precise data about disturbances in osteoarticular biomechanics, aimed at initiating immediately an accurate treatment for each injury type [1].

Last, but not least, Greer Richardson, in his "Fractures and dislocations of the foot, reviews thoroughly foot injuries on targeted osteoarticular segments, depending on their biomechanic involvement in the entire complex [5, 7].

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The most important contribution is the meticulous clinical-anatomical classification of every entity, thus offering support for optimal treatment of every anatomic injury [10] and goal is to obtain a very good 46 2 surgical result, that is a correct osteoarticular alignment, by the standardization of both the approach route and of the means and methods of internal and external fixation in relation with the type of injury according to the anatomical-clinical classification [4].

Currently, the surgical means of internal and external fixation associated to bone and soft tissue reconstruction in the complex trauma of the foot are presented in detail [7[.

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The first three metatarsals articulate with the three corresponding cuneiforms: medial, middle and lateral. The fourth and fifth metatarsals articulate with the cuboid bone Figure 1.

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Figure 1 Lisfranc joint - osteo-ligamentous anatomy [5] Bone alignment of this articular complex is particularly important in understanding the therapeutic considerations of this region [1,3].

Intrinsic stability is due both to the deep location of the second metatarsal base, and even more to the strong ligament complexes attached to every tarsometatarsal joint.


Lisfranc ligament, the strongest ligament of this ligament complex, originates in the plantar-lateral aspect of medial cuneiform and inserts into the plantar-medial of second metatarsal base [4] Pedal artery crosses the midfoot right above the second tarsometatral joint, being particularly predisposed to destruction during Lisfranc injuries, often associated with the onset of compartment syndrome. Deep peroneal nerve, providing innervation to the first intermetarsian space, can also be injured [2].

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The study of this joint mobility shows two distinct components [4. Medial column which is a continuation of the talus, scaphoid and the three cuneiforms with their corresponding metatarsals and lateral column, represented by the calcaneus, cuboid and two lateral metatarsals.

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The three medial joints have less mobility, equal to one third of the mobility in the two joints that form the lateral column. The relative medial rigidity is particularly important in ensuring regional stability.