Treatment of open to the tarsometatarsal joint injury / 中华创伤骨科杂志

ABSTRACT

Objective To discuss the treatment and clinical outcome of open to the tarsometatarsal joint injury. Methods From April 2009 to April 2010,14 patients,10 males and 4 females,with open to the tarsometatarsal joint injury were treated in our department.They were 45 years old on average (from 21 to 67 years old).Five of them had the tarsometatarsal complex involved.According to Chiodo and Myerson's classification,all the injuries were of three-column type. Medial and lateral column shortening was respectively concomitant in 2 cases.Two patients had combined soft tissue defects and one patient degloved dorsal skin.A thorough debridement and Kirschner wire fixation following reduction were performed for all patients in the emergency room.A mini external fixator was applied in patients with medial or lateral column shortening.The degloved skin was thinned and grafted in situ,followed by vacuum sealing drainage (VSD) to cover the wound.The soft tissue defect was covered by VSD after debridement.All the patients had a definitive internal fixation after the soft tissue condition improved, and 3 of them had soft tissue coverage simultaneously.Functional outcomes were scored by American Orthopedic Foot Ankle Society (AOFAS) system. Results One patient with degloving injury had partial skin necrosis which was treated by debridement,definitive internal fixation and local flap transfer on the 13th day after emergency operation.A definitive internal fixation and skin graft were performed in 2 patients with soft tissue defects respectively on the 7th or 11th day post-operation.No wound infection or necrosis occurred in other patients.Twelve patients were followed up for an average period of 18 months (from 13 to 25 months).Solid union was obtained 12 weeks on average (from 10 to 16 weeks) after the secondary surgery.No flap necrosis,infection,nonunion or osteomyelitis occurred during the follow-up.Two patients had tarsometatarsal arthrodesis at the 12th or 14th month respectively due to severe pain and function limitation caused by post-traumatic arthritis.The mean AOFAS midfoot score at the last follow-up was 72 (from 61 to 89). ConclusionsAs tnanagement of open to the tarsometatarsal joint injury is a great challenge,surgeons must take soft tissue condition into consideration.Tenporary Kirschner wire fixation or in combination with external fixation after early thorough debridement,reduction and alignment restoration,followed by secondary definitive internal fixation until soft tissue condition improves is a safe and effective treatment strategy to decrease soft tissue complications and obtain stable fixation.