Yu Xiao, Pang Qing-Jiang, Yu Guang-Rong
Xiao Yu, Department of Orthopedics Centre, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China.
Qing-jiang Pang, Department of Orthopedics Centre, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China.
Pak J Med Sci. 2013 Apr;29(2):687-92. doi: 10.12669/pjms.292.2996.
The surgical management to the injuries of the fourth and fifth tarsometatarsal (TMT) joints is controversial. We briefly review the anatomical characteristics to the injuries, the diagnosis, as well as the individualized treatment of the injuries of the fourth and fifth TMT joints by open reduction and internal fixation, TMT arthrodesis and arthroplasty. We conclude that open reduction and internal fixation is the recommended option for acute injuries, while arthrodesis can be used in cases of malunion of the fourth and fifth TMT joints with gross pain or arthritic changes and obvious structural deformity. Arthroplasty is an effective salvage operation mainly used in high-demand patients with severe TMT arthritis. Finally, we propose a recommended treatment algorithm (based on the literature and our experience), taking into account the specific indications for internal fixation, TMT arthrodesis and arthroplasty to optimize the individualized treatment. Data sources/Study selection Data from survey reports, descriptive, cross-sectional and longitudinal studies published from 2002 to 2012 on the topic of the injuries to the fourth and fifth tarsometatarsal joint on human and radiography studies were included. Data Extraction The data was extracted from online resources of American Orthopaedic Foot & Ankle Society, American Academy of Orthopaedic Surgeons, US National Library of Medicine, The MEDLINE. Conclusion It is important to comprehend the specific anatomical characteristics and grasp the strict indications, advantages and disadvantages of the ORIF, TMT arthrodesis and arthroplasty to optimize the individualized treatment of the fourth and fifth TMT joints injuries in a maximum extent.
第四和第五跗跖关节损伤的手术治疗存在争议。我们简要回顾了这些损伤的解剖学特征、诊断方法，以及通过切开复位内固定、跗跖关节融合术和关节成形术对第四和第五跗跖关节损伤进行的个体化治疗。我们得出结论，切开复位内固定是急性损伤的推荐选择，而关节融合术可用于第四和第五跗跖关节畸形愈合伴有严重疼痛或关节炎改变及明显结构畸形的病例。关节成形术是一种有效的挽救手术，主要用于对跗跖关节严重关节炎有较高需求的患者。最后，我们提出一种推荐的治疗算法（基于文献和我们的经验），考虑到内固定、跗跖关节融合术和关节成形术的具体适应证，以优化个体化治疗。数据来源/研究选择纳入了2002年至2012年发表的关于人类第四和第五跗跖关节损伤主题的调查报告、描述性、横断面和纵向研究的数据以及影像学研究数据。数据提取数据从美国足踝外科协会、美国骨科医师学会、美国国立医学图书馆、MEDLINE的在线资源中提取。结论了解特定的解剖学特征并掌握切开复位内固定、跗跖关节融合术和关节成形术的严格适应证、优缺点，对于最大程度优化第四和第五跗跖关节损伤的个体化治疗非常重要。
