In his presentation, J. Tracy Watson, MD, noted Lisfranc or tarsometatarsal fractures are traditionally fixed with two longitudinal incisions and open reduction of the medial column followed by one of two dorsal approaches. The 1st approach is a medical incision between the first and second rays and the intercuneiform joint, but, if needed, a lateral incision can be performed between the fourth and fifth matatarsals.

Previously published research has also shown patients with ligamentous Lisfranc injuries have beter ourcomes with primary fusion, according to Watson.

"The key is not to dismiss this as an ankle sprain' or a "foot sprain" because, often, these are overlooked and they do not get the necessary evaluation and you miss these chronic ligamentous injuries," Watson Said. Patients with talar fractures can be treated with close reduction either in the emergency department or the OP, according to Watson. However, he said the key to good outcomes is making sure the patient's skin will allow for definitive fixation.

Although the vascularity of the talas does not make talar neck fractures emergencies, Watson said surgeons should consider soft tissue injuries and neurovascular concerns.

Finally, with calcaneal fractures, Watson noted surgeons can reduce the fracture by reducing the sustentacular fragment with a plate or screw. Addional wires can also be added to maintain overall stability, he said.

Once he joint is largely restored, Watson noted surgeons can either leave the injury alone to heal, allow the soft tissues to heal before performing a formal extensile lateral approach to restore lateral wall and narrow heel or evaluate the soft tissues medially and perform a sinus tarsi approach to restore the lateral wall and reduce subfibular impingement - by Casey Tingle

Disclosure: Watson reports he is on the editorial panel for the Journal of Bone and Joint Surgery, the Journal of Orthopedic Trauma, Clinical Orthopaedicsand related research, the Journal of Trauma, is a chair of the American Academy of Orthopedic Surgeons Biological Implants and Regenerative Medicine Committee.