Introduction: Unstable Lisfranc (tarsometatarsal) joint injuries are increasingly being treated by open reduction and internal fixation.

Hypothesis: A good outcome is achievable by anatomical reduction and internal fixation of these injuries.

Methods: This was a retrospective outcome-analysis involving 21 patients. Six were treated non-operatively. There sere eight ligamentous and seven ligamentous/osseous injuries.

The patients’ outcomes were assessed with the use of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and the long-form Musculoskeletal Function Assessment (MFA) score.

Results: The average follow-up was11 months. One patient developed a post-operative infection, and another developed a deep-vein thrombosis. The average AOFAS score was 71 and the average MFA score was 32. The study group as a whole sustained their injuries through low-energy trauma, therefore comparison with other studies should take this into account.

Conclusions: Follow-up in this study was short an this was reflected in the scoring. Longer follow-up will allow a greater evaluation of final outcome.

Although described by Gattelier and Chastang in 1924, the transfibular approach to the ankle has been slow to emerge as a conventional orthopaedic technique. To date, applications have been confined to the treatment of tibiotalar arthrodesis, ankle joint incongruity and exposure of the fractured talus, where the distal fibula is also fractured. While seemingly undocumented, it is also proving effective in mosaic-plasty of the talus. This paper outlines an innovative technique of segmental distal fibula osteotomy and its role in the treatment of osteochondritis dissecans of the postero-lateral talar dome.