Management of Tarsometatarsal Joint Injuries
Review Article Management of Tarsometatarsal Joint Injuries Abstract Brian M. Weatherford, MD Joint disruptions to the tarsometatarsal (TMT) joint complex, also John G. Anderson, MD known as the Lisfranc joint, represent a broad spectrum of pathology from subtle athletic sprains to severe crush injuries. Although injuries Donald R. Bohay, MD, FACS to the TMT joint complex are uncommon, when missed, they may lead to pain and dysfunction secondary to posttraumatic arthritis and arch collapse. An understanding of the appropriate anatomy, mechanism, physical examination, and imaging techniques is necessary to diagnose and treat injuries of the TMT joints. Nonsurgical management is indicated in select patients who maintain reduction of the TMT joints under physiologic stress. Successful surgical management of these injuries is predicated on anatomic reduction and stable fixation. Open reduction and internal fixation remains the standard treatment, although primary arthrodesis has emerged as a viable option for certain types of TMT joint injuries. he tarsometatarsal (TMT), or these injuries often result in painful TLisfranc, joint complex is com- posttraumatic arthritis and arch posed of the TMT, intertarsal, and collapse. Early diagnosis and main- proximal intermetatarsal joints.1 The tenance of anatomic reduction of the unique osseous anatomy of the TMT joints are necessary to maxi- midfoot along with the stout liga- mize patient function. JAAOS Plus Webinar mentous support allows effective Nevertheless, appropriate initial Join Dr. Weatherford, Dr. Anderson, force transfer from the hindfoot to treatment of TMT injuries is contro- and Dr. Bohay for the interactive the forefoot during ambulation. versial. A variety of techniques have JAAOS Plus Webinar discussing “Management of Tarsometatarsal Joint Injuries to the TMT joint complex are been described for the management Injuries,” on Tuesday, July 11, 2017, at rare, accounting for only 0.2% of all of TMT injuries, but rates of post- 8 pm Eastern Time.
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