injuries to the fourth and fifth tarsometatarsal joints: a review of the surgical management by internal fixation, arthrodesis and arthroplasty

ABSTRACT

The surgical management to the injuries of the fourth and fifth tarsometatarsal [TMT] joints is controversial. We briefly review the anatomical characteristics to the injuries, the diagnosis, as well as the individualized treatment of the injuries of the fourth and fifth TMT joints by open reduction and internal fixation, TMT arthrodesis and arthroplasty. We conclude that open reduction and internal fixation is the recommended option for acute injuries, while arthrodesis can be used in cases of malunion of the fourth and fifth TMT joints with gross pain or arthritic changes and obvious structural deformity. Arthroplasty is an effective salvage operation mainly used in high-demand patients with severe TMT arthritis. Finally, we propose a recommended treatment algorithm [based on the literature and our experience], taking into account the specific indications for internal fixation, TMT arthrodesis and arthroplasty to optimize the individualized treatment