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Arthrodesis of the Fourth and Fifth Tarsometatarsal Joints in a Sensate Patient with Post-Traumatic Arthritis: A Case Report and Surgical Technique
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Active Orthopedics and Sports Medicine LLC, Forked River, NJ. Dr. Costa is now with Ocean County Foot and Ankle Surgical Associates, Toms River, NJ.
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Lateral column arthrodesis of the tarsometatarsal joints is a highly controversial topic in foot and ankle surgery, with minimal prospective research and reproducible findings in the current literature. Arthrodesis of the lateral fourth and fifth tarsometatarsal joints, when performed, is most often done secondary to post-traumatic osteoarthritis or Charcot’s neuroarthropathy deformity. This case report focuses on arthrodesis of the lateral column in a patient with post-traumatic osteoarthritis from a previously sustained Lisfranc fracture-dislocation. The patient also experienced a cavus foot deformity that was addressed with a lateral displacement calcaneal osteotomy. Arthrodesis of the fourth and fifth tarsometatarsal joints was found to be successful on this patient, with bony union noted to occur radiographically 12 weeks postoperatively. In addition, the patient experienced significant reduction in her preoperative pain and an ability to return to activities of daily living. Regular visits during an 18-month postoperative period occurred, with the patient continuing to have satisfactory results and a significant reduction in preoperative pain levels. One postoperative complication was encountered 15 months postoperatively: painful hardware, which resulted in the removal of both calcaneal screws and one screw from the fourth tarsometatarsal arthrodesis site. This case report proposes that lateral column arthrodesis may be performed successfully in select patients where other joint-preserving procedures may not be applicable. Herein we outline a suggested surgical technique with hardware that can be used to reproduce these findings and assist surgeons who are unfamiliar with performing this procedure.
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