Short-term effectiveness of Endobutton plate in reconstruction of Lisfranc ligament / 中国修复重建外科杂志

Objective: To observe the short-term effectiveness of Endobutton plate in the reconstruction of Lisfranc ligament in tarsometatarsal joint injury. Methods: Between March 2015 and July 2018, 18 patients with tarsometatarsal joint injuries were treated with Lisfranc ligament reconstruction by Endobutton plate. There were 12 males and 6 females with an average age of 32.5 years (range, 16-55 years). The causes of injury were traffic accident in 8 cases, falling from height in 3 cases, crushing by a heavy objective in 4 cases, and spraining in 3 cases. There were 10 cases of Myerson type A, 4 of type B1, 2 of type B2, 1 of type C1, and 1 of type C2. The interval between injury and operation ranged from 3 to 9 days (mean, 4.9 days). X-ray examination was performed regularly after operation to measure the distance between the first and the second metatarsal joints, and the visual analogue scale (VAS) score was used to evaluate the pain relief. At last follow-up, the reduction of tarsometatarsal joint was evaluated by measuring and comparing the height of the affected and healthy arches. The foot function was evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: The average follow-up time was 15.8 months (range, 10-28 months). All incisions healed by first intention. X-ray reexamination showed that there was no screw loosening or plate fracture. There were significant differences in the distance between the first and the second metatarsal joints and VAS score at 3 months after operation, before removal of the internal fixator, and at last follow-up when compared with preoperative values ( P0.05). At last follow-up, there was no significant difference in the arch height between affected foot [(5.3±0.2) mm] and healthy foot [(5.4± 0.3) mm] ( t=1.798, P=0.810). The AOFAS score of foot function was 89.5±7.3 with excellent in 12 cases, good in 4 cases, and fair in 2 cases. The excellent and good rate was 88.9%. Conclusion: The reconstruction of Lisfranc ligament with Endobutton plate can stabilize the tarsometatarsal joint and achieve satisfactory foot function at early stage.

Non-osseous Coalition of the Third Metatarsal-Lateral Cuneiform Joint: A Case Report / 대한족부족관절학회지

This paper reports a rare case of the symptomatic third metatarsal (MT3) - lateral cuneiform (LC) in a 55-year-old male who presented with complaints of severe intermittent pain in his right foot. Plain radiographs and computed tomography scans revealed sclerosis and irregularity at this joint. The intraoperative findings demonstrated a fibrocartilaginous coalition. The pain had improved one year after removing the MT3-LC joint by en bloc and arthrodesis.

Effects of multi-block reconstructive plate on the treatment of complex tarsometatarsal joint injury / 中国综合临床

Objective To evaluate the effect of multi?plate reconstruction plate in the treatment of partial complex tarsometatarsal joint injury injuries. Methods Seven patients treated complex tarsometatarsal joint injuries with multi?plate reconstruction plate in Nanjing Hospital Affiliated to Nanjing Medical University from September 2014 to July 2016 were selected in this study. According to Myerson classification,3 cases were A type,3 cases were B type,1 case was C type. The therapeutic effects were observed. Results The patients were followed up for 6-12 months,with an average of (8. 6±2. 0) months. According to the foot scoring criteria in American Orthopedic Foot and Ankle Society ( AOFAS) ,the function of the foot was evaluated,3 cases were in excellent condition,4 cases were in good condition. Conclusion In the case of multiple metatarsal fractures of the metatarsal base involved in the joint surface, the use of multiple reconstructive plates for joint fixation reduces the iatrogenic damage of the joint surface. The fixation effect and the functional recovery are satisfactory

Radiographic classification of tarsometatarsal joint dislocation and postoperative imaging evaluation / 实用放射学杂志

Objective To study radiographic classification of tarsometatarsal joint dislocation and postoperative imaging evaluation.Methods 74 patients with tarsometatarsal joint dislocation were included in this study.Tarsometatarsal joint dislocations were classified by the Myerson fracture displacements classification.All patients were evaluated according to the American Orthopedics Foot & Ankle Society (AOFAS)clinical rating systems.Results There were 19 patients with Myerson A,46 patients with Myerson B and 9 patients with Myerson C tarsometatarsal joint dislocation.39 distal tarsal bone fractures and 156 metatarsal fractures,with simultaneous scaphoid fractures in 10 patients were showed.All patients who were followed up and no infection.The AOFAS scale was categorized as excellent,good,fair or poor,and 22 patients were considered as excellent,29 patients as good,17 patients as fair and 6 patients as poor.Postoperative imaging evaluation required anatomical reduction of tarsometatarsal joint.On the anteroanterior radiogragh,the base medial edge of the second metatarsal bone and the medial edge of intermediate cuneiform were combined to form a straight line.The shortest distance between the base of the first metatarsal bone and the second metatarsal bone should be less than 2 mm.On the medial oblique radiogragh,a smooth line connecting the medial edge of the fourth metatarsal bone with the medial edge of cuboid bone always appeared.On the lateral radiogragh,the dorsal edge of the second metatarsal bone and intermediate cuneiform formed a smooth line.The height of metatarsus should not exceed the dorsal edge of corresponding cuneiform.The longitudinal arch angle was restored within normal limits.Conclusion The type-B tarsometatarsal joint dislocation is the most common type and frequently accompanies by multiple fractures.Intraoperative and postoperative multidirectional observation of anatomical reduction of tarsometatarsal joint dislocation can reduce incidence of posttraumatic arthritis.

Surgical treatment for open tarsometatarsal joint injury / 中国骨伤

<p><b>OBJECTIVE</b>To discuss the surgical method and clinical efficacy for open tarsometatarsal joint injuries.</p><p><b>METHODS</b>From March 2011 to January 2015, 21 patients with open tarsometatarsal joint injuries were treated with stage-surgery method, including 14 males and 7 females with an average age of 45.6 years old ranging from 20 to 75 years. Injury site occurred in the left foot of 13 cases and right foot of 8 cases. Traffic injury was in 5 cases, crush injury in 6 cases, heavy crushing was in 10 cases. According to Myerson to classify for tarsometatarsal joint injury, 5 cases were type B2, 9 cases were type C1, and 7 cases were type C2. And according to Gustilo to typing for soft tissue injury, 5 cases were type IIB, 10 cases were type IIIA, 6 cases were type IIIB. Fracture healingand complications were observed after operation and clinical effects were evaluated according to the midfoot score of AOFAS.</p><p><b>RESULTS</b>All the patients were followed up from 11 to 40 months with an average of 16.2 months. The fracture healing time was from 10 to 16 weeks with an average of 12.3 weeks. No complications such as deep infection, nonunion and osteomyelitis were found. Midfoot score of AOFAS at last follow-up was 83.0±14.9, 9 cases got excellent results, 8 good, 2 fair, 2 poor. Two patients complicated with severe traumatic arthritis once again underwent tarsometatarsal arthrodesis.</p><p><b>CONCLUSIONS</b>For the treatment of open tarsometatarsal joint injury, reasonable debridement, comprehensive assessment for the soft tissue injury, correctly grasp the surgical indications and time of internal fixation, can reduce the incidence of deep infection and osteomyelitis.</p>

Lisfranc Joint Injuries: Diagnosis and Treatment

Injuries to the Lisfranc joint are relatively rare, but they are often misdiagnosed or inadequately treated, resulting in poor long-term outcomes. Understanding of anatomical structure and injury mechanism, careful clinical and radiographic evaluations are needed to recognize and treat Lisfranc joint injuries. In this article, we review the anatomy, biomechanics, injury mechanisms, injury classification, clinical presentation, radiographic evaluation, treatment, outcome, and complications of Lisfranc joint injuries.

Radiographic Characteristics and the Clinical Results of the Operative Treatment of the Tarsometatarsal Osteoarthritis with Hallux Valgus Deformity / 대한족부족관절학회지

PURPOSE: To evaluate the radiographic characteristics of the tarsometatarsal osteoarthritis with hallux valgus deformity and report the clinical results of the operative treatment. MATERIALS AND METHODS: This is a retrospective study of 20 patients, 22 feet who had been operated for non-traumatic tarsometatarsal osteoarthritis with hallux valgus (TMT group) and control group of hallux valgus patients without tarsometatarsal osteoarthritis (26 patients, 28 feet) from April 2004 to July 2011. Radiographic characteristics were compared between the groups, using hallux valgus angle, 1st-2nd intermetatarsal angle, metatarsal length ratio, metatarsus adductus angle, talonavicular coverage angle, talus-1st metatarsal angle, calcaneal pitch angle and medial cuneiform height. Pre- and postoperative difference of 1st-2nd metatarsal declination angle and distance between the 1st-2nd metatarsal head were evaluated. The clinical results were evaluated by American Orthopaedics Foot and Ankle Society (AOFAS) midfoot scale and visual analogue scale (VAS). RESULTS: Metatarsal length ratio was significantly larger in TMT group (p<0.001). Metatarsus adductus angle, talonavicular coverage angle, talus-1st metatarsal angle on lateral radiograph, calcaneal pitch angle and medial cuneiform height were different from control group (p<0.001, p<0.001, p=0.001, p=0.010, p=0.006). Postoperative declination of the 2nd metatarsal and distance between the 1st-2nd metatarsal head were increased (p=0.009, p=0.001). The AOFAS and VAS score were improved (p<0.001, p<0.001). CONCLUSION: Non-traumatic osteoarthritis of the tarsometatarsal joints seems to be associated with long 2nd metatarsal length, metatarsus adductus and flatfoot deformity. Spur excision may be successful to relieve symptoms when the arthritis was diagnosed in early stage.

Cannulated screws internal fixation plus three-column reconstruction for treatment of Lisfranc' s joint injuries / 中华创伤杂志

Objective To evaluate the preliminary outcome of cannulated screw internal fixation in treatment of the tarsometatarsal joint injuries.Methods From January 2005 to October 2010,21 patients(14 males and 7 females)with the tarsometatarsal joint injuries were treated.Their age ranged from 21 to 62 years(average 38.2 years).According to anatomical three-column classification,there were four patients with single medial column injury,four with medial and middle column injuries,three with middle and lateral column injuries,two with single lateral column injury and eight with three column injuries.The injury causes included traffic injury in nine patients,machine injury in eight and fall from height injury in four.The period from injury to admission was 2-15 hours(mean 5 hours).During operation,open reduction was performed,followed by internal fixation with the cannulated screw.X-ray examination was done in the regular follow-up and function was evaluated by using Maryland scoring system.Results Of all,19 patients were followed up for 4-47 months(mean 20 months),which showed no infection,loosing or breakage of the internal fixation.According to the Maryland scoring system,the clinical outcome was rated as excellent in eight patients,good in seven,fair in two and poor in two,with excellence rate of 79％.Conclusions The three-column theory plays an important role in clinical diagnosis and therapy of the tarsometatarsal joint injuries.Open reduction and cannulated screw internal fixation may attain satisfactory clinical results in treatment of the tarsometatarsal joint injuries.

Effects of transverse arch reconstruction by modified Youngswick osteotomy on young and middle-aged hallux valgus / 中国矫形外科杂志

[Objective]To evaluate the effect of transverse arch reconstruction by modified Youngswick osteotomy on young and middle-aged hallux valgus. [Methods]From November 2005 to November 2008,25 female(36 feet) hallux valgus patients with the average age of 37.7years old(range 22 to 49 years old) were treated surgically.All feet had hypemobility of the first tarsometatarsal joint and collapse of the transverse arch of the foot.In the operation,the first metatarsal head was pushed laterally,downward and rotated downward.Modified McBride procedure was used on the correction for hallux valgus deformity.The X-ray films of all patients were obtained before operation,and 12 months after operation.The hallus valgus angle and intertatarsal angle were measured and analyzed on radiographs.The surgical outcome was evaluated combined with the Gu Xiang-jie's score.All pamameters were statistically analyzed.All cases were followed-up regularly.[Results]Twenty-one cases(28 feet) were followed-up for averaged 15.9 month.Hallax valgus angle reduced from 26.8??1.07? to 11.1??0.29?,intertatarsal angle reduced from 14.9??1.36? preoperatively to 8.3??1.19? postoperatively.The painful callus beneath the forefoot was alleviated or diminished obviously in all cases.Based on Gu Xiangjie'score,the subjective assessments were given as excellent in 16 feet,good in 7 feet,and fair in 5 feet.The good to excellent result was 82.1%.[Conclusion]For the hallux valgus with hypermobility of the first tarsometatarsal joint and transversal arch collapse,modified Youngswick surgery can recover the transverse arch,correct first metatarsal adduct abnormality,and regain the weight-bearing function of the first metatarsal head.Modified Youngswick surgery is an ideal choice for young and middle-aged hallux valgus because of less complications and reliable surgery outcomes.

Surgical Treatments and Clinical Outcomes for Idiopathic Osteoarthritis of the Tarsometatarsal Joints / 대한족부족관절학회지

PURPOSE: The purpose of the study was to identify the subtypes of idiopathic osteoarthritis of the tarsometatarsal joints based on accompanying hindfoot, midfoot, or foot deformities and their corresponding surgical options and also to evaluate the overall clinical results. MATERIALS AND METHODS: The study included 59 patients (67 feet) with idiopathic tarsometatarsal joint osteoarthritis. Tarsometatarsal fusion was performed for tarsometatarsal joint and accompanied secondary change was divided into subtypes and various bony reconstruction was carried out. The patients were evaluated with the AOFAS midfoot score and FFI. The average patient age was 60.2 years with 40.6 months follow-up. Fifty-four feet (80.6%) had been treated with realignment fusion. Twenty-six feet had first and second tarsometatarsal joint fusion, and 20 feet had first tarsometatarsal fusion only. Six subtypes were identified based on associated foot deformities: 1) in-situ without deformities (18%), 2) pes planovalgus (45%), 3) rockerbottom (15%), 4) cavus foot (1%), 5) hallux valgus (12%), and 6) hallux valgus with pes planovalgus or rockerbottom (9%). Plantar-medial closing-wedge resection was used in 10 feet to correct rockerbottom. For pes planovalgus, a medial sliding calcaneal osteotomy was done. Lateral column lengthening with medial sliding calcaneal osteotomy was done for severe pes planovalgus, and triple arthrodesis was done for rigid pes planovalgus. Hallux valgus was corrected with the Lapidus procedure (85.7%). RESULTS: AOFAS midfoot scores improved from preoperative 34.1 points to postoperative 83.9 points (p<0.05). The Foot Function Index postoperatively also showed significant improvement (p<0.05), with a high satisfaction rate (86.6%). There were 29 complications, most commonly sesamoid pain. CONCLUSION: Idiopathic tarsometatarsal OA feet can be classified into six categories. Pes planovalgus feet should be treated with medial sliding calcaneal osteotomy, lateral column lengthening, or triple arthrodesis in addition to tarsometatarsal joint realignment fusion. Rockerbottom and hallux valgus deformities should also be addressed.

A study on anatomic and CT features of the fourth and fifth tarsometatarsal joints / 重庆医科大学学报

Objective:To study the anatomic and CT features of the fourth and fifth tarsometatarsal joints.Methods:Thirty foot specimes taken from cadavers were randomly selected;the articular facets of the cuboid bone,fourth and fifth tarsometatarsal bones were observed and measured.As a control,thirty cases of normal adult foots underwent spiral CT(GE MEDICAL SYSTEMS Bright Speed CT16)scan with transverse and coronal and sagittal planes.With GE ADW4.2 workstations,the image data were reconstructed in 3-dimension.The structures of articular facets of the cuboid bone、fourth and fifth tarsometatarsal bones were 3D observed.After that the data were analyzed.Results:3-dimensional reconstruction spiral CT could clearly demonstrate the morphology and pattern of the articular facet of the fourth and fifth tarsometatarsal joint.Conclusion:3-dimensional reconstruction spiral CT can provide assist in diagnosis of the foot injury,especially to the guide restitution of the lateral longitudinal arcus during the operation.

Tarsometatarsal Fracture: Dislocation / 대한정형외과학회잡지

Tarsometatarsal injury has not been paid much attention due to it is unusual frequency. But the cases of tarsometatarsal injuries are on the increase in proportion to the increasing "high energy trauma injury" resulted from the traffic and industrial accidents. The purpose of this study is both assessing the relative effects among clinical results, final radiologic findings, treatment results and symtoms. In view of the results so far achieved from 20 cases of tarsometatarsal fracture dislocation which had been treated at Sung-Ae general hospital from January 1990 to December 1993, the results were as follows: 1. Thirteen cases were treated by open reduction and 3 cases were treated by closed reduction with smooth pins but no reduction loss were experienced. 2. Traumatic arthrosis could be observed in 14 cases but there were no influences on the functional end results. 3. Anatomical results correlated with pain. 4. Anatomical or neraly anatomical reduction was considered as most important factor of prognosis.

Experience of the Tarsometatarsal Fracture-Dislocation / 대한정형외과학회잡지

Injury of the tarsometatarsal joints is known to be very uncommon. Injury was most frequently seen as the result of high energy trauma and appear to be occuring more frequently. Early recognition was imperative, since significant long-term disability can result from inadequate treatment. We have reviewed and clinically anafysed 14 cases of tarsometatarsal Fracture-Dislocation treated at our clinic during the period frrqn March 1980 to March 1985. The following result were obtained. 1. Majority of cause of injury was traffic accidents in 10 cases(71%). 2. According to the Wilsons classification, First stage of supination was most common. 3. Associated injuried was 92%. 4. There was no significant difference between operative treatment and conservative treatment.