title: Categorization and surgical management of posttraumatic midfoot malunion.
abstract: OBJECTIVE
  To assess a classification system for midfoot injury that was based on the characteristics of the foot malunion and to evaluate the suggested treatment strategies.
  
  
  METHODS
  This retrospective review of data from patients with posttraumatic midfoot malunion categorized each foot deformity into one of three types based on the foot arch and then separated these categories into one of three subtypes based on the forefoot deformity. According to the types of malunion, fascio-cutaneous flap, osteotomy, joint arthrodesis or realignment was used to correct the deformity. Patients were assessed before surgery and at 12 and 24 months postoperation.
  
  
  RESULTS
  Of the 24 patients identified, six had Lisfranc joint injuries, nine had Lisfranc joint complex injuries combined with cuboid compression fractures and nine had Lisfranc joint complex injuries combined with navicular fractures. Overall, eight patients presented with poor soft tissue and massive scar at the dorsal foot. Visual analogue scale and American Orthopaedic Foot and Ankle Society midfoot scores significantly improved over the 24-month study period. At the end of the study, 21 of 24 patients (87.5%) rated their functional outcome as excellent or good.
  
  
  CONCLUSIONS
  The classification of the midfoot malunion evaluated in this study may be helpful in the decision making process for surgical intervention.
authors.affiliation: Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Chun-Guang
authors.initials: CG
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China yuguangrong1953@163.com.
authors.forename: Guang-Rong
authors.initials: GR
authors.lastname: Yu
authors.affiliation: Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Yun-Feng
authors.initials: YF
authors.lastname: Yang
authors.affiliation: Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018409:Foot Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D055815:Young Adult
keywords: Midfoot injuries; fractures; malunion; surgical procedures