Lisfranc injury is named after Jacques Lisfranc, a field surgeon in Napoleon’s army.

Based on Columnar classification of Lisfranc fracture dislocation, study of injury to medial column was carried out as they have the potential to be a severe cause of residual disability in the foot if not properly treated at the initial stage. Importance of Medial column is that it forms the highest point of longitudinal arch and may be injured in isolation or in association with lateral and middle column. Complex deforming forces may cause unusual pattern of medial column injuries at more than one level. There is renewed interest in this injury over past decade as modalities of treatment have changed over a period of time from conservative to fixation with K-wires to rigid fixation with screws to fixation with absorbable screws or combination of above.

We present 21 cases of medial column injuries in Lis-franc fracture-dislocation. Age ranged from 18 to 65 yrs. All were male. Four fixed with compression screws,12 fixed with K-wires, 2 managed conservatively, 3 were neglected cases. Post-operatively POP back splint was given, K-wire removal at 8 weeks, screw removal after 12 weeks and partial weight bearing started at 8-12 weeks. Follow-up ranged from 3 months to 3 years.

They were graded on basis of residual pain, foot shape, and movements. Best results were seen in cases where rigid intertarsal / intercolumnar stability was achieved by screw fixation. There was residual inter-cuneiform subluxation in 4 cases, which were fixed with K-wires, and this led to residual pain. Conservative/neglected cases had poor results.

Intercolumnar / intertarsal instabilities should be primarily recognized and stabilized under compression. Stabilization should not only be within the 3 columns but also intercolumnar, thus maintaining the relative length of 3 columns and hence reconstitution of medial longitudinal arch.

Skin and soft tissue loss is very common in modern high velocity trauma. Such wounds pose problem of coverage. We present a good alternative to skin grafting & flaps i.e. SINGH’S skin traction device for wound closure in these patients.

The technique is based on the principle of tissue expansion and makes use of viscoelastic properties of the skin i.e. creep and stress relaxation. 100 cases with 116 wounds with skin and soft tissue loss were treated. Two parallel kirshner wires (1.5mm) were passed through the dermis on either side of the wound margins and interconnected by compression device consisting of threaded rod having two blocks and compression knob. Gradual compression approximated the wound margins. Patients ranged in age from 15 to 65 years with average age of 30.5 years. Main modes of injury were roadside accidents and machinery accidents. Average operating time was about 20 minutes. 50 amputation stump wounds were also treated.

Excellent results were observed in 48 (41.4%), good in 42 (36.2%), fair in 14 (12%) and poor in 12 (10.4%) wounds. Main complication was cutting through of wires.

We found that this technique is simple, economical and effective. No special training and instruments are needed and can be done by junior surgeon at small centres. It provides full thickness cover to the wound which matches the surrounding normal skin in quality, sensations and colour. Above all this technique can be successfully used in infected wounds and wounds with exposed bone and tendons. Careful gradual compression judged by pain and blanching gives better results and fewer complications.