[Treatment tactics in fractures of the midfoot]

Metatarsal fractures can occur as isolated lesions in combination with injuries of the ipsilateral tarsus, or in chain injuries of the lower extremity, or within a polytrauma. The choice of surgical or conservative therapy depends significantly on localisation and dislocation of the fracture (especially the involvement of the metatarsus I or V), as well as on the extent of the primary or expected soft part damage. From 1974 to 1984, 137 patients with metatarsal fractures were treated as in patients at the Accident Hospital in Tübingen. Three groups of diseases indicated for surgery are evident from an analysis of the courses of the disease: Metatarsal fractures in combination with an ipsilateral tarsus fracture or tarsus dislocation. Metatarsal serial fracture especially in involvement of metatarsus I and/or V. Dislocated tear fracture of the base of the fifth metatarsal bone. Preference is given to percutaneous Kirschner wiring from the head of the injured metatarsal bone. The tear fracture of the base of the metatarsal bone V is treated via traction bandage. These methods are generally technically simple and enable early functional treatment and partial weight-bearing. In particular, immediate surgical treatment may not only favour reposition and retention, but may also limit damage of the soft parts.