Injuries of the midtarsal joint.
Injuries involving the midtarsal joint, which are frequently misdiagnosed, have been studied to clarify the mechanism, classification and treatment. The necessity for routine antero-posterior, lateral and oblique radiographs is emphasised. Seventy-one injuries have been classified according to the direction of the deforming force:medial, longitudinal compression, lateral, plantar and crush types are described. Included in the medial and lateral types is a hitherto undescribed tarsal rotation or "swivel" injury. The mechanism whereby longitudinal compression causes fractures of the body of the navicular is described, and two varieties having different prognoses are defined: one due to purely longitudinal compression and the other due to longitudinal compression with a medial component. The results of treatment have been assessed clinically and radiologically. Reduction, open if necessary, with internal fixation, is recommended for displace fractures: primary arthrodesis is not indicated. For severe persistent symptoms from medial and longitudinal force injuries triple arthrodesis is recommended, and from lateral force injuries, calcaneo-cuboid arthrodesis.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001174:Arthrodesis; D002370:Casts, Surgical; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries; D005592:Fracture Fixation; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013180:Sprains and Strains / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D013314:Stress, Mechanical; D013640:Tarsal Joints / Q000000981:diagnostic imaging