Reconstructions after inveterated fractures and dislocations of the foot

Inveterated fractures or dislocations of the foot which are defined as being more than 6-12 weeks old can be secondarily reconstructed anatomically in only very rare cases. All other cases need reorientation of all axes of the foot requiring single or combined joint fusion. In cases of significant post-traumatic bone necrosis the dead bone has to be radically resected and substituted by an autogenous bone graft from the iliac crest. Old cases of dislocation, for example after subtalar dislocation without anatomical reduction, need reorientation of the foot axes by performing arthrodesis. Subluxation of the medial Lisfranc joint after an unrecognized rupture of Lisfranc ligament can be controlled later by anatomical repair of this ligament by using half of the extensor digitorum longus tendon and thus avoiding arthrodesis.