Injury to the tarsometatarsal joint complex

Area of Science:

• Orthopedic Surgery
• Trauma Care
• Foot and Ankle Surgery

Background:

• Tarsometatarsal joint complex fracture-dislocations result from direct (crush) or indirect (axial load) trauma.
• These injuries may involve compartment syndrome, soft-tissue damage, and open fracture-dislocations.
• A significant percentage (up to 20%) of these injuries are initially missed, highlighting the need for high suspicion.

Purpose of the Study:

• To review the mechanisms, diagnosis, and treatment of tarsometatarsal joint complex fracture-dislocations.
• To emphasize the importance of early recognition and appropriate management.
• To report on the outcomes of surgical intervention.

Main Methods:

• Review of injury mechanisms, including direct and indirect trauma.
• Discussion of diagnostic imaging, favoring computed tomography (CT) over standard radiography.
• Description of surgical treatment, specifically open reduction and internal fixation (ORIF).

Main Results:

• Computed tomography is the preferred imaging modality for diagnosing subtle injuries.
• Open reduction and internal fixation, utilizing screws for medial rays and Kirschner wires for lateral joints, is the preferred treatment.
• Approximately 90% of patients achieve a satisfactory outcome with this approach.

Conclusions:

• Early diagnosis and treatment of tarsometatarsal joint complex injuries are crucial for optimal outcomes.
• Surgical restoration of the tarsometatarsal joint complex is effective in achieving a pain-free, functional foot.
• Open reduction and internal fixation provide reliable and successful results in the majority of cases.