Tarsometatarsal arthrodesis with a bridging plate for Lisfranc malunion

Abstract

Objective To evaluate the surgical techniques and clinical outcomes of tarsometatarsal arthrodesis with a bridging plate in the treatment of Lisfranc malunion.Methods From January 2008 to August 2010,26 patients with Lisfranc malunion (26 feet) were treated by tarsometatarsal arthrodesis with a bridging plate in our department.They were 18 males and 8 females with an average age of 34.6 years (from 18 to 65 years).The duration from injury to operation ranged from 6 to 13 months (average,8.9 months).Thorough radiographic examinations including weight-bearing X-ray and 3-D reconstruction CT scan were carried out before surgery so as to formulate an individualized surgical protocol.X-rays were taken during follow-ups to confirm the bone healing.Their American Orthopaedic Foot and Ankle Society (AOFAS) scores,visual analogue scale (VAS) and The Short Form-36 (SF-36) scores before operation and at the last follow-up were recorded and compared.Results Nineteen patients obtained a mean follow-up of 16.4 months (from 12 to 30 months).The other 7 were lost to the follow-up.All the wounds healed at the first stage without soft tissue complications.The postoperative X-ray showed that the fusion healed after an average of 12 months.At the last follow-up,their AOFAS score increased significantly from preoperative 49.6 ± 15.4 points to postoperative 76.8 ± 11.5 points,their VAS score decreased significantly from preoperative 5.7 ± 3.2 points to postoperative 1.4 ±0.8 points,and their SF-36 score increased significantly from preoperative 38.7 ± 7.4 points to postoperative 74.0 ± 6.4 points (P ＜ 0.05).Talonavicular arthritis occurred in 2 patients who had moderate to severe pain and limitation of walking which were cured by talonavicular arthrodesis.No implant failure,fusion failure or malunion occurred.Conclusion Anatomical reconstruction of the midfoot alignment followed by tarsometatarsal arthrodesis with a bridging plate is an effective and reliable treatment of Lisfranc malunion. Key words: Foot deformities, acquired; Arthrodesis; Fracture fixation, internal; Lisfranc malunion