Transverse Dorsal Approach to the Midfoot Joints in Acute Traumatic Injury

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A transverse dorsal incision approach to the joints of the midfoot was previously described in a small study of 12 patients by Vertullo et al in 2002. Of those patients, 10 cases were elective procedures and only 2 were cases of acute traumatic injury to the midfoot. Thus, here we studied acute traumatic midfoot dislocations and fractures in a large group of 60 patients. We treated them with a surgical approach, which we feel can provide superior exposure to the midfoot through a single transverse incision rather than through the traditional multiple longitudinal incision approach. We found that of our 60 patients, 55 healed the incision without complications. The remaining 5 patients showed delayed wound healing that required secondary treatment. Five of the patients who healed well had some embarrassment of sensation secondary to either the incision or the trauma. We conclude that this approach for an acutely traumatized midfoot appears safe and carries little risk of wound breakdown or neurological problems. Moreover, we feel that this is an optimal approach not only for elective but also in particular for traumatic cases.Level of Evidence: Diagnostic Level 3. See Instructions for Authors for a complete description of levels of evidence.

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