Treatment of tarsometatarsal joint injury with dorsal spanning plate

Abstract

Objective To evaluate clinical outcomes of dorsal spanning plate in treatment of tarsometatarsal joint injury.Methods Between May 2009 and May 2011,31 cases of closed tarsometatarsal joint injury with comminuted fracture of the metatarsal base were treated in our department.They were 19males and 12 females,with an average age of 46.2 years (from 24 to 70 years).The tarsometatarsal joint complex was involved in 8 cases.An open reduction and dorsal spanning plate fixation was performed after the soft tissue situation was ameliorated.Regular X-ray follow-ups were carried out to evaluate overall outcomes using American Orthopaedics Foot and Ankle Society (AOFAS) midfoot score,36-item Short Mos Form Health Survey (SF-36 score) and visual analogue scale (VAS),and complications were also recorded.Results Of all the patients,25 were followed up for an average of 24 months (from 12 to 36 months).There were no such soft tissue complications as wound infection,skin and flap necrosis.X-ray demonstrated bony union at an average of 12 weeks (from 10 to 15 weeks) postoperation.The average AOFAS midfoot score was 78.0 points (from 45 to 95 points),SF-36 score 79.2 points (from 45 to 96 points) and VAS score 1.7 points (from 0 to 8points) at the final follow-up.Screw breakage was found in one patient without complaints at 9 months postoperation and the implant was removed.Obvious pain and limited function caused by post-traumatic arthritis were found at 14 months and 20 months postoperation respectively in 2 patients who had to undergo an arthrodesis eventually.Conclusion Treatment of tarsometatarsal joint injury with dorsal spanning plate is safe and effective,with advantages of operative simplicity and avoidance of iatrogenic damage of articular cartilage. Key words: Foot injuries; Bone plates; Fracture fixation, internal