Objective To investigate the treatment method and effectiveness of fresh closed fracture-dislocation of the midtarsal joint. Methods Between April 2004 and April 2011, 73 patients (75 feet) with fresh closed fracture-dislocation of the midtarsal joint were treated with closed reduction combined with open reduction and internal fixation. There were 56 males (58 feet) and 17 females (17 feet), aged from 19 to 62 years (mean, 35.8 years). Injuries were caused by falling from height in 35 cases, by sprain in 4 cases, by machine twist in 5 cases, by heavy pound in 9 cases, and by traffic accident in 20 cases. The time from injury to admission ranged from 1 hour and 30 minutes to 48 hours (mean, 4.5 hours). According to Main’s classification standard, 6 feet were rated as vertical compression injury, 33 feet as medial displacement injury, 17 feet as lateral displacement injury, 9 feet as flexion injury, and 10 feet as crush injury. Concomitant injuries included midfoot fracture-dislocation (34 feet), scaphoid fracture (6 feet), cuboid bone fracture (18 feet), calcaneal fracture (8 feet), talus fracture (7 feet), tibiotalar joint dislocation (2 feet), subtalar joint dislocation (2 feet), medial malleolus fracture (1 foot), and acute compartment syndrome (3 feet). Results Healing of incision by first intention was achieved in 65 cases (67 feet), by second intention in 8 cases (8 feet). Sixty-two cases (62 feet) were followed up from 11 months to 7 years and 11 months (mean, 3 years and 6 months). After operation, feet pain occurred in 26 cases, and stiffness or discomfort of the affected foot in 36 feet when walking. The X-ray examination showed good reduction of fracture-dislocation of the midtarsal joint and concomitant injuries with no re-dislocation or bone nonunion in 59 feet; 3 feet had flatfoot secondary to navicular necrosis, and underwent arthrodesis. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 77-90 (mean, 88.6) at last follow-up. Conclusion According to the preoperative evaluation of the damage, using the manual reduction combined with internal fixation (mini-plate or hollow screw with Kirschner wire) methods can obtain good effectiveness in the treatment of fracture-dislocation of the midtarsal joint.
Objective To analyse and summarize the diagnosis, treatment, and cl inical effects of talus lateral process fracture. Methods Between February 2001 and March 2009, 21 male patients with an average age of 33.6 years (range, 18-46years) with talus lateral process fractures were treated. Fracture was caused by fall ing from height in 18 cases, by tumbl ing in 2 cases, and by sprain in 1 case. According to Hawkins classification, there were 4 cases of type I, 15 cases of type II, and 2 cases of type III, all being closed fractures. The disease course was from 2 hours to 26 days. In 17 patients whose fracture fragments were more than 1 cm × 1 cm × 1 cm or whose fracture fragments shifting was more than 1 mm, open reduction and internal fixation with AO hollow titanium nails were performed in 14 patients, open reduction and internal fixation with door-shape self-made nail in 1 patient, and open reduction and internal fixation with absorbable screws in 2 patients. In 4 patients whose fracture fragments were less than 0.6 cm × 0.5 cm × 0.5 cm or whose fracture fragments shifting was less than 1 mm, fragments removel was performed in 2 patients, Kirschner pins in 1 patient, and plaster conservative therapy in 1 patient. In patients with l igaments injury, the l igaments was reconstructed during the operation. Results All the incisions achieved primary heal ing. Twenty-one patients were followed up 9.5 months to 8 years. No ankle pain occurred and the range of joint motion was normal after operation. The X-ray films showed that all cases achieved fracture union. And the healing time was from 8 weeks to 14 weeks (10 weeks on average). According toAmerican Orthopeadic Foot amp; Ankle Society (AOFAS) for foot, the results were excellent in 17 cases, good in 3 cases, and moderate in 1 case; the excellent and good rate was 95.24%. Conclusion The size and displacement of fracture fragment should be considered first in the treatment of lateral process fracture of talus; in patients who are compl icated by lateral malleolus l igament injury, the l igament should be reconstructed to avoid the chronic non-stabil ity of lateral ankle.