The treatment of tarsometatarsal injuries

In order to analyze the value of operative treatment for tarsometatarsal injuries, 31 consecutive fracture-dislocation injuries from 1975 to 1988, and 11 cases of undislocated injuries were reviewed. Forty patients (41 injuries) could be contacted. The average follow up was 5 years. Twenty-two of the dislocated injuries were treated with open reduction and fixation, usually K-wires. All injuries were classified radiologically. By means of a questionnaire, it was found that 7 had excellent results, 13 good, and 21 poor. No case where anatomical reduction was not achieved could be classified as excellent, and half (5 of 10) received full disability pension. When anatomical reduction was achieved, half had good or excellent results and only 5 of 20 received a disability pension. Initially undislocated injuries had a better prognosis, with 8 of 11 having excellent or good results, and none receiving pension. These injuries should be treated aggressively with open reduction and fixation when there is any displacement. Despite this treatment, one-half of patients with dislocated injuries as well as one-fourth of those with initially undislocated injuries will still suffer from pain and permanent disability probably due to soft tissue damage and instability.