RESULTS OF ARTHRODESIS OF THE TARSOMETATARSAL JOINTS AFTER TRAUMATIC INJURY

We retrospectively reviewed the records of thirty-two patients who had had an arthrodesis of the tarsometatarsal joints for intractable pain after a traumatic injury of the midfoot. The arthrodesis was performe d at a mean of thirty-five months (range, six to 108 months) after the injury. All of the procedures were performed with use of rigid intern al fixation, and twenty-four patients, in whom a defect had been creat ed by debridement of the joints, were managed with an autogenous bone graft. Nine patients had at least one concomitant procedure, including a claw-toe procedure (eight patients), a reconstruction of the poster ior tibial tendon (three patients), an excision of an interdigital neu roma (three patients), an arthrodesis of the calcaneocuboid joint (one patient), and an arthrodesis of the ankle (one patient). Complication s included neuritis in three patients; metatarsalgia in two; malunion in two; and asymptomatic non-union, wound slough, superficial infectio n, and reflex sympathetic dystrophy in one each. The patients were eva luated at a mean of fifty months (range, twenty-four to 105 months) af ter the arthrodesis. The evaluation included a physical examination, r adiographs, and use of the rating scale of the American Orthopaedic Fo ot and Ankle Society for the evaluation of the midfoot. The mean posto perative score of 78 (of a possible 100) points was significantly bett er than the mean preoperative score of 44 points (p = 0.02). With the numbers available, we could not show that the extent of the arthrodesi s, the involvement of other joints in the hindfoot or the forefoot, th e mechanism of injury, or whether the injury was work-related signific antly affected the functional outcome.