Gunshot wounds of the tarsal joints

Abstract

Gunshot wounds of the tarsal joints have unsatisfactory results with prolonged conservative therapeutic methods. One hundred two cases of missile wounds of the tarsal joints are presented, nine of which terminated in amputation. Seventeen patients have normal painless motion; ankylosis has occurred in thirty-seven, and thirty-nine patients have painful limited motion. Only 53 per cent of the 102 patients have painless weight-bearing extremities. The prognosis of wounds of multiple tarsal joints is more guarded for normal painless gait than wounds limited to an individual tarsal joint. Fragmentation wounds have a higher incidence of infection than wounds due to small arms time. The duration of sepsis has decreased with modern antibiotics and current surgical technics. Amputation of the involved extremity should be performed only if bony loss or sepsis is so severe as to necessitate the procedure. A painful joint with limited motion is more disabling than an ankylosed joint, and an early decision concerning surgical arthrodesis should be made.