Typing and operative management of malunion after midfoot injury

Abstract

Objective To characterize clinical treatment of the malunion after midfoot injury.Methods A retrospective study was carried out of the 22 cases of malunion following complex midfoot injury who had been admitted to our hospitals from June 2004 through June 2012.They were 19 men and 3 women,16 to 65 years of age (mean,37.8 years).There were 6 cases of Lisfranc joint injury 7 cases of Lisfranc joint complex injury combined with cuboid compression fracture and 9 cases of Lisfranc joint complex injury combined with navicular fracture.Eight patients presented with poor soft tissue and massive scar at the dorsal foot.The foot deformity was categorized into 3 types and 3 subtypes repectively,with type Ⅰ indicating normal foot arch (type Ⅰa forefoot abduction,type Ⅰb forefoot adduction and type Ⅰc normal forefoot),type Ⅱ Pes Cavus deformity (type Ⅱa combination with forefoot abduction,type Ⅱb combination with forefoot adduction,and type Ⅱc normal forefoot),and type Ⅲ flatfoot deformity (type Ⅲa combination with forefoot abduction,type Ⅲb combination with forefoot adduction,and type Ⅲc normal forefoot).There were 2 cases of type Ⅰa,4 cases of type Ⅰc,9 cases of type Ⅱa,4 cases of type Ⅲ a,and 3 cases of type Ⅲc in our cohort.According to the malunion typing,fascio-cutaneous flap,osteotomy,joint arthrodesis,or realignment was used to correct deformity.Clinical outcomes were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS)midfoot score and visual analogue scale (VAS).Results All the patients were followed up for an average of 34.7 months (range,from 15 to 53 months).The mean VAS score was 2.0 points (range,from 0 to 6 points) and the mean AOFAS score was 83.9 points (range,from 73 to 94 points) at the last follow-up,giving an excellent to good rate of 81.8％.All cases obtained favorable functional outcomes without bone nonunion,except for one patient who still suffered from midfoot walking discomfort 3 years after operation.Conclusions Operative management of malunion following midfoot injury is effective and good results can only be obtained by stabilizing the injured joint,realignment and restoring foot arch.Our typing of the midfoot malunion is helpful in the operative treatment. Key words: Foot injuries; Foot deformities, acquired; Surgical procedures, operative