Lisfranc arthrodesis for chronic pain: a cannulated screw technique.

Nine patients with injury to the tarsometatarsal joint underwent fusion with cannulated screw fixation after conservative treatment had failed. Symptoms consisted of localized pain, forefoot abduction, and progressive collapse of the medical column. Early diagnosis and treatment were associated with a better functional outcome. The technique involved either a single or double incisional approach, resection of joints, reduction and fixation with cannulated cancellous screws. A total of 43 joints were fused: 37 tarsometatarsal joints and 6 tarsal joints. A partial Lisfranc joint complex fusion (medial three joints) was performed in four patients and a total joint complex fusion was performed in five patients. Intertarsal fusion was performed when pathologic change was evident. A cannulated screw was used to fixated 40 of the 43 joints fused. Reduction was performed prior to arthrodesis, when significant fracture-dislocation had occurred. The cannulated self-tapping cancellous screw technique provides a method of reduction that decreases technical difficulty while providing compression across the fusion site. After an average follow-up of 29 months (range 20 to 36 months), seven patients (78%) rated their outcome as good. One patient had a fair result (11%), and one patient had a poor result (11%).