TARSOMETATARSAL JOINT DISLOCATION OR FRACTURE DISLOCATION

From a review of 60 cases of tarsometatarsal dislocations or fracture dislocations, the authors realize that careful X-ray analysis can detect incomplete dislocation. X-rays with the foot in 60° eversion help in diagnosing dorsal displacement of the first or second metatarsal base. For exploring vessels in cases complicated by circulatory embarrassment, the dorsalis pedis artery must be explored first from the dorsal foot wound in compound injuries, while the posterior tibial vessels must be first explored in closed injuries. Internal fixation with Kirschner wire is insufficient to counteract the tension exerted by muscular pull. Percutaneous suture with stain- less steel wire provides sufficient force for good reduction. Following tarsometatarsal joint arthrodesis, care must be taken to mould the cast so that immobilization ensures good foot alignment preventing deformity.