![]() ![]() Through the same incision, the second metatarsal was reduced by removing base of 2nd metatarsal and distal end of intermediate cuneiform and fused with a 4 mm cannulated cancellous screws. The first metatarsal and medial cuneiform was aligned and fixed with a 5 holed 2.7 mm plate to achieve a 1st tarsometatarsal joint arthrodesis. To reduce the base of the first metatarsal, osteotomy at the base of first metatarsal and distal aspect of medial cuneiform (to shorten and achieve reduction) was done. ![]() Reducing the first metacarpal was very difficult even after releasing all the adhesions and fibrous tissue. The dorsalis pedis artery and deep peroneal nerve were identified and tagged. In supine position and keeping the knee in flexion and ankle in neutral position a longitudinal skin incision of size 5 cm was made in the 1st dorsal we space between the first and second metacarpal, the incision extends from the web space to the mid tarsal region. The patient was taken up for surgery after obtaining informed consent. (a-c) Radiographs at the time of presentation showing homolateral type of Lisfranc with fleck sign. 1c) were taken to ensure that other fractures are not missed. Multiple radiographic views including 30° oblique ( Fig. CT of the foot was not taken at the time of presentation. On careful examination of the radiographs, multiple chip fractures were present in the region of base of second metatarsal indicative of fleck sign ( Fig. Radiographs taken at the time of presentation showed a neglected homogenous lateral type of Lisfranc injury ( Fig. The neurovascular status of the lower limb was intact. The patient was able to perform the ankle movements but the subtalar and mid foot joint movements were painful and restricted. There was a diffuse swelling and tenderness over the left mid foot region and the foot was grossly deformed. The patient presented to us 6 weeks following the initial injury. ![]() On removing the splint after 1 month, there was persistent pain and swelling over the left foot. The patient underwent native splinting for 1 month. Following the injury, he developed pain and swelling over his left foot and he was not able to weight bear weight on the injured limb. A 53-year-old gentle man presented with alleged history of fall from a twenty-foot tree and sustained closed injury over his left foot. ![]()
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