Tarsometatarsal Joint (TMTJ) Injury Treated by External Fixator Assistant Surgery

Introduction: The TMTJ has a specialized bony and ligamentous structure, providing stability to this joint. It is an uncommon injury, often missed, resulting in long term disability.

TMTJ injury is difficult to assign for a treatment protocol and difficult to treat. The treatment needs reduction, fixation and rehabilitation.

Materials and Methods: We will present the clinical results in a case series which included the use of an external fixator for reduction and immobilization of 10 patients, with a TMTJ injury; treated over a period of 31 months. One patient had osteogenesis imperfecta and one had neurologic abnormalities. All were evaluated by CT. The apparatus construction is important and we described the suggested architecture; reduction over axis, fixation and compression over axis according to the dislocation type, use of internal fixation in case of need. Patients were evaluated using the AOFAS midfoot score (pain, daily activity capacity, walking capacity and correct stance position), over a period of 3-12 months post-surgery.

Results: We present the preliminary results: 3 of the patients needed additional internal fixation for comminution and one needed a Lapidus procedure. In the follow up, all the patients were ambulatory with no limp in three months. One had neuralgia at one year follow up. Patchy osteoporosis was identified in 3 patients three months post-surgery. the reduction was satisfactory for all the patients. The average AOFAS score was 75.3.

Conclusions: According to the literature, we expect prolonged convalescence up to one year. However, our proposed technique yields satisfactory results which indicate that the external fixator added value in this pathology. Due to limited sample size, a further survey in the future is required.