Dislocations of the Tarsometatarsal Joint

Abstract

A series of nine cases of tarsometatarsal dislocation due to indirect trauma with a follow-up from two and a half to fifteen years is presented. Distinction is made between dislocations due to direct and those due to indirect trauma. It is our opinion that, despite the superficial similarity between the two, the lesions are quite different in mechanism of production, direction of displacement, and extent of soft-tissue damage. Their treatment and prognosis also differ. In this series, all the dislocations were due to indirect violence; seven cases were fresh and two were old injuries of months' or years' duration. Reduction was accomplished by closed and open methods. Partial redislocation occurred after both methods in some instances. Two patients had persistent marked dislocation. In all patients followed for two and a half years or more the functional end results were excellent even when severe widespread dislocation persisted. Despite these facts, we believe when dislocation recurs or when closed methods of reduction fail, open reduction and internal fixation with Kirschner wires are advisable. Open reduction provides a better looking foot and appreciably hastens convalescence. In this series none of the dislocations, not even the persistent widespread ones, caused symptoms that suggested the need for surgical fusion. Although disastrous circulatory disturbances have been described in the literature, none were experienced in this series.