Name: Midfoot Dislocations and Treatment Options
Uploaded: 2019-10-15T00:00:00Z
Channel: Arthrex
Description: Thomas G. Harris, MD, (Pasadena, CA) presents cases demonstrating the treatment options for midfoot dislocations.

<p>Thomas G. Harris, MD, (Pasadena, CA) presents cases demonstrating the treatment options for midfoot dislocations.</p>

Not Hidden

English  - en

video

VID1-000657-en-US | A | Midfoot Dislocations and Treatment Options

Thomas G. Harris

Human

Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

Videos von Fallpräsentationen

Case Presentation Videos

Cirurgiões que apresentam um ou mais casos clínicos.

Vídeos apresentações de casos

Cirujanos que presentan uno o más casos clínicos.

Video presentaciones de casos

Midfoot Dislocations and Treatment Options

Hi guys. My name is Tom Harris. I'm from Pasadena, California. I work at Congress Orthopedics there, as well as the Chief of Foot and Ankle at Harbor UCLA in Torrance. And I wanted to go over a couple of cases involving midfoot dislocations and kind of the way to treat that, be it with fusions or fixation and different techniques in terms of what to use for those type of fractures and dislocations. The first one involves a 25 year old who was involved in a motorcycle accident. You can see from that dramatic x ray a complete dislocation of the first TMT joints, and then fractures through the second through fifth metatarsal necks with significant comminution. And then there's another oblique view of things, as well as the lateral view, which shows the dislocation and the displacement noted. So now what what's going to be our approaches. What are our concerns. Are we going to fix or fuze that first TMT joint. And are we going to use plates or pins for the lesser metatarsals. So in this case we use some temporary fixation to realign that first TMT joint with K-wires. That was a dorsal medial incision for the first TMT joint. We made another incision between the second and third metatarsal, and yet another between the fourth and fifth. And so, given the nature of that fracture, I like to use pins for these lesser metatarsals. It allows for a little micro motion. These fractures heal with calluses. These are extraordinarily difficult to do closed. So I'll always make an open incision and do antegrade retrograde fixation with these K-wires. So I choose open and I'm choosing K-wires on this as opposed to plates. You can see that fourth metatarsal fracture was hard to reduce. It was incarcerated. There's really no way you're going to get that unless you open it. We needed to distract it and then place K-wires across that area there. And then we've gone on to use the Lapidis plate for the first TMT joint. And we did perform an arthrodesis in this case. Given the nature of the injury, how displaced it was, and how much energy went into that foot, I think this has to be better served with effusion primarily as opposed to an RAF. So we did the first TMT Arthrodesis and then the lesser metatarsals were fixed with K-wires. And you can see we also have that screw outside of the plate there. And X-rays at four months out really show nice fusion of the first EMT joint. So despite that dramatic looking X-ray and the really pretty significant displacement there, we've gone on to get a functional foot there that's gone on to heal really nicely. And another case we had recently involved a 52 year old contractor that had pretty minimal fall, three foot fall. But you can see there's a complete dislocation of that midfoot. The lateral columns off the third TMT joints dislocated, the second TMT joints dislocated. And so for these cases it's another difficult thing in terms of fix or fuze. Here you can see the nice close reduction which is really important. That decreases the amount of swelling that the patient's going to have. It makes this surgery a little less urgent given that it was reduced initially. And we're going to fix or fuze this. Well in this case I'm going to choose to fuze it. Just given the nature of the injury here and how displaced it was initially, the incision windows are important for these. So in the past I've used an incision more dorsal between 1 and 2 and another incision closer to three and four. And I'm always worried that that skin bridge isn't quite enough, and you can note here that early, subtle abduction to the foot as it starts to predictably go into more and more abduction with this sort of injury. So here's our approaches. We have a plantar incision there, which we've used the plantar plate for, and then a dorsal incision with a spreader that we've been able to distract the TMT joints and reduce that. And so the nice part about this is you can use that plantar plate. And then the dorsal U plate which is allows a wide wound window which is really important for these high energy injuries that have a lot of swelling. And that's our final construct. You can see that reverse lisfranc screw that's going from the base of the second into the medial cuneiform, holding the lisfranc joints together there. And then we have a plantar lapidis plate that we've used through a medial approach. And then that dorsal u plate is placed with the dorsal lateral approach. Now going straight for the medial plantar lapidis plates allows you more freedom and safety for your dorsal incision. And you can safely make that dorsal incision lateral to the neurovascular bundle, so you don't have to worry about getting that neurovascular bundle with your incision. You can note the reverse lisfranc screw that we've seen there. It's technically easier given the open exposure to the lateral side of the second metatarsal joint. We have two pins going from the fifth metatarsal into the cuboid. They don't have to be one from the fourth and one from the fifth. I think of it as a bookend. So I just put two pins in from the fifth metatarsal into the cuboid, and I always use the JumpStart dressing. Wasn't always a believer on it early on, but I'm a big adapter to it. So just put the dots down. And I think JumpStart dressing really has something to it. I've noticed a significant decrease in the number of wounds we're seeing post-operatively with these JumpStart dressing. So there's this final construct. It's got a nice reduction of that lateral column. We're fuzing the second and third as well as the first TMT joints. And I think having that variability with that plantar lapidis plate makes it much easier to do that and much easier in terms of wound healing as well. So that's our final construct in terms of the lateral view there. And he's gone on to do really nicely. So thank you very much.

Midfoot Dislocations and Treatment Options

Related Pages

Foot and Ankle

Comprehensive Fixation System

Product

Foot and Ankle

Lisfranc Arthrodesis

Procedure

Foot and Ankle

Midfoot Plating Module

Product

Foot and Ankle

Plantar Lapidus Plate

Product