[Corrective tarsometatarsal arthrodesis for malunion after fracture-dislocation]

Malunited fracture dislocations at the tarsometatarsal (Lisfranc's) joint regularly lead to painful deformities with severe functional impairment for the affected patients. Malunions result from initially overlooked injuries as well as from misjudged and inadequately treated injuries. Depending on the nature of the primary dislocation, either abduction or adduction of the forefoot will result, accompanied by a planus or cavus deformity. Corrective arthrodesis aims at axial realignment at the tarsometatarsal junction, and elimination of residual instabilities especially after pure ligamentous injuries. Fusion should be limited to the medial metatarsocuneiform joints if full realignment of all five metatarsals can be achieved with this procedure. A review of the literature revealed that corrective tarsometatarsal arthrodesis reproducibly leads to considerable pain reduction and functional improvement with patient satisfaction between 69% and 100%. Favourable prognostic factors are anatomic realignment and limited fusion of the first to third metatarsocuneiform joints.