Irreducible Tarsometatarsal Fracture-dislocation

Abstract

Three mechanisms may prevent closed manipulative reduction of the tarsometatarsal fracture-dislocation: anterior tibialis tendon interposition, incongruity of the medial cuneiform-1st metatarsal articulation and interposition of a fracture fragment in the 2nd metatarsal-intermediate cuneiform joint. Awareness of these mechanisms will assist in the surgical approach to the irreducible tarsometatarsal fracture-dislocation. Such an irreducible fracture-dislocation in a 25-yr-old man was successfully reduced openly; anatomic reduction and normal passive range of ankle motion resulted. The patient had a slightly painful midfoot during walker ambulation 10 wk postinjury.