The Diagnosis and Treatment of Injury to the Tarsometatarsal Joint Complex

Although the eponym 'Lisfranc dislocation' is still often used to describe injuries to the tarsometatarsal joints, the term is misleading.It probably originated from the time of Napoleon and relates to injury to the foot sustained in falling from a horse, accompanied by severe vascular damage which necessitated amputation, the only method of treatment used by Lisfranc, surgeon to the Emperor.Since then, the incidence of severe vascular complications associated with injuries to the tarsometatarsal joint has declined to the extent that the only circumstances under which circulatory compromise is treated is in the presence of a compartment syndrome.Injuries to the midfoot are best described as those affecting the tarsometatarsal joint complex (TMC) which includes all the bones and joints directly or indirectly involved in a tarsometatarsal fracture-dislocation, including the cuneiforms, cuboid, and navicular.1 Although high-energy injuries to the TMC occur commonly today after motor-vehicle, motorcycle, and industrial accidents, they may also be seen in association with minimal trauma from minor twisting injuries, particularly in athletes and the elderly. 2The concepts of the treatment of injury to the TMC have changed markedly over the past decade.In 1986, Myerson et al 1 highlighted the severe morbidity associated with these injuries and identified the factors associated with a poor outcome, particularly residual angulation of the metatarsals or diastasis of greater than 2 mm between the base of the first and second metatarsals.Failure to obtain an anatomical reduction is the most significant reason for a poor result.In these patients, the treatment had either been non-operative or, if surgery had been performed, Kirschner wires (K-wires) had been used for fixation.It was further recognised that premature removal of these K-wires resulted in subsequent diastasis or redislocation.Arntz, Veith and Hansen 3 first popularised the use of screws in preference to K-wires and, since then, there have been a number of papers emphasising the need for anatomical reduction stabilised by rigid forms of internal fixation.2,4-8