Lisfranc arthrodesis for residual deformity

The causes of residual deformity with posttraumatic painful arthritis after tarsometatarsal (Lisfranc) fracture-dislocation with the need for correcti onal arthrodesis are in our experience (22 cases over 5 years) overseen inj uries in one third, closed reduction and immobilisation or inadequate fixat ion technique with K-wires in another two thirds of cases. Foot malalignmen t and residual instability is assessed with weight-bearing radiographs of b oth feet, adduction/abduction stress films and CT scans for complex deformi ty. Correction is carried out via two longitudinal dorsal incisions, strict epiperiosteal preparation and debridement of the Lisfranc joint of all rem aining cartilage, sclerosis and fibrous tissue. Reorientation begins, in th e same manner as primary open reduction, with anatomical alignment of the s econd metatarsal base to the second cuneiform. Defects are filled with auto logous bone grafting, stable fusion can be achieved with 3.5 mm cancellous compression screws. Full weight bearing is allowed in a modelled plaster sh oe for 6 to 8 weeks. The functional medium-term results are convincing with 15 of 17 patients seen after 13 months of follow-up working full time. The Maryland Foot Score improved from 38.9 to 76.8 points in these patients.