The diagnosis and treatment options of tarsometatarsal joint complex injuries
SONG Mou-ke
XIA Tian
YE Zhe-wei
CHEN Qiang
ZHANG Guo-lei
Abstract： Objective To investigate the diagnosis and clinical results of different surgical procedures of tarsometatarsal joint complex injuries. Methods From February 2008 to May 2011, 34 cases of tarsometatarsal joint complex injuries were retrospectively analyzed. There were 23 males and 11 females, who all had single-foot injuries. Their average age was 39.5 years old ( range;17-62 years ). According to the Myerson classification, there were 7 cases of middle column injuries, 16 cases of medial-middle column injuries and 11 cases of three-column injuries. 13 patients were treated with close reduction and percutaneous internal fixation, and 19 patients were treated with open reduction and internal fixation. 2 patients were treated with one-stage arthrodesis. The curative effects on the function of affected feet were evaluated using the american orthopedic foot and ankle society ( AOFAS ) midfoot score. Results All patients were followed up for an average period of 22 months ( range;12-36 months ). All incisions healed by first intention. The postoperative function was evaluated according to the AOFAS midfoot score:6 cases had excellent results, 17 good, 9 fair and 2 bad, and the excellent and good rate was 67.6%. After close reduction and percutaneous internal fixation and one-stage arthrodesis, the excellent and good rate was 100%, which was 42.1% after open reduction and internal fixation. Postoperative complications included looseness of K-wires in 8 patients ( 3 patients receiving close reduction and internal fixation and 5 patients receiving open reduction and internal fixation ), screw breakage in 2 patients ( 1 patient receiving close reduction and internal fixation and 1 patient receiving open reduction and internal fixation ) and traumatic arthritis in 7 patients ( all 7 patients receiving open reduction and internal fixation ). Conclusions Anatomical reduction and stable fixation are the basic principles in treating tarsometatarsal joint complex injuries. For patients with tarsometatarsal joint complex injuries, the anteroposterior, lateral and 30° oblique X-ray films of the affected feet may be compared with that of the contralateral feet, if necessary. CT plays an important role in diagnosing tarsometatarsal joint complex injuries, based on which occult fractures can be easily found. Fractures and Lisfranc ligament injuries can both be shown on MRI. The patients with tarsometatarsal joint complex injuries can be effectively treated with close reduction and percutaneous internal fixation, with small trauma and low complications;With large trauma and high complications, open reduction and internal fixation can only be used when close reduction is failed or in patients with more severe fracture–dislocation. One-stage arthrodesis has low complications, but affects the function of patients, which can be used in patients with torn ligaments, intra-articular comminuted fractures or dislocation and frequently-occurring traumatic arthritis.
Keywords：Foot jointsLigamentsFoot injuriesDiagnosisTherapy
Publication Date：2013-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 382-385 )