(iii) Tarsometatarsal injuries-Lisfranc injuries

Lisfranc injuries are relatively uncommon injuries but with increasing motor vehicle use their incidence may be increasing. Missed injuries can lead to chronic pain, deformity and disability and this can be avoided by having a high index of suspicion. Subtle injuries are difficult to diagnose and special imaging or stress X-rays are useful in diagnosis. The classification proposed by Hardcastle et al. (J Bone Joint Surg 64-B (1982) 349) is used most commonly and the aim of treatment must be to obtain an anatomical reduction and stable fixation as soon as possible. Treatment after 6 weeks yields poor results and salvage arthrodesis is inferior to primary reduction and stabilisation. Reduction may be by closed or open methods and fixation by K wires, screws or bioabsorbable screws. Complications occur frequently and need to be detected and managed appropriately.