The injuries to the fourth and fifth tarsometatarsal joints: A review of the surgical management by internal fixation, arthrodesis and arthroplasty

Anatomic Description of the Fourth and Fifth Tarsometatarsal Articulation: A Cadaveric Study

The fourth and fifth tarsometatarsal joint, consisting of the fourth and fifth metatarsal and the cuboid, imparts a significant amount of motion to the foot during ambulation. Injury to this joint complex, through chronic deformation or acute trauma, often necessitates arthroplasty, arthrodesis, or fusion. Currently, there exists no studies that investigate the anatomy of this articulation. The purpose of this study is to describe the medial and lateral anterior cuboid articulations which allows for surgical planning and the advancement of hardware design. Twenty fresh-frozen below-the-knee cadaver legs were thawed and the cuboids were excised. The width and height of the entire joint complex were measured as the longest span across the total articular surface of the anterior cuboid. The width and height of each articular facet were recorded as the span across the geometric bisection of each individual surface. The mean anterior cuboid articulation width and height was 25.62 mm and 16.74 mm, respectively. The mean medial cuboid articulation width and height was 11.7mm and 13.65 mm, respectively. The mean lateral cuboid width and height was 16.74 mm and 12.78 mm, respectively. The medial articulation maintained a larger mean height and narrower mean width than the lateral facet (p < .05). The unique anatomy of the lateral tarsometatarsal joint complex plays an important functional role and requires attention when deciding between arthrodesis or arthroplasty. Increasing the understanding of the clinical anatomy of this joint will better prepare surgeons and product designers to anticipate hardware needs.

Fractures of the Cuboid Bone: A Critical Analysis Review

Cuboid fractures rarely occur in isolation, and a high index of suspicion for the presence of Chopart, Lisfranc, or complex midfoot injuries should be raised. The cuboid is the cornerstone of the lateral column and acts as a bridge between the lateral column and the transverse plantar arch. Its most important role is maintenance of lateral column length and associated motion in the midtarsal and tarsometatarsal joints. To date, a classification system that is validated for clinical practice (i.e., guidance for management and prediction of outcome and prognosis) is lacking. The principles of operative treatment are restoration of articular congruity, lateral column length, and stability of the Chopart and Lisfranc joints. Nonoperative management is reserved for nondisplaced articular fractures (<1 mm) or avulsion fractures that are caused by low-energy trauma.

Effect of different fusion types on kinematics of midfoot lateral column: a comparative biomechanical study

Background

This study aimed to compare the biomechanical outcomes of the isolated 4^th or 5^th tarsometatarsal (TMT) joint arthrodesis with the whole lateral TMT joints arthrodesis.

Methods

Ten cadaveric lower legs underwent isolated 4^th TMT joint arthrodesis, 5^th TMT joint arthrodesis, and whole lateral TMT joints arthrodesis in sequence. Texson F-scan and K-scanTM joint sensor were used to test the medial and lateral plantar pressure and the pressure of calcaneocuboid joint.

Results

Compared with the intact foot, the lateral forefoot pressure increased significantly (P<0.05) after 4^th TMT joint fusion. The medial forefoot pressure was significantly lower in the 5^th TMT joint fusion than that in the intact foot (P<0.05) and the 4^th TMT joint fusion (P<0.05), but higher than that in the whole lateral TMT joints fusion (P<0.05). On the contrary, the lateral forefoot pressure was significantly higher in the 5^th TMT joint fusion than that in the intact foot and the 4^th TMT joint fusion, but lower than that in the whole lateral TMT joints fusion (P<0.05). The medial forefoot pressure was the lowest (P<0.05) and lateral forefoot pressure was the highest (P<0.05) in the whole lateral TMT joints fusion. The calcaneocuboid joint pressure increased respectively with the intact foot being the lowest, followed by the isolated 4^th TMT joint arthrodesis, the isolated 5^th TMT joint arthrodesis, and the whole lateral TMT joints arthrodesis (P<0.05).

Conclusions

The isolated 4^th or 5^th TMT joint arthrodesis has less impact on the pressure of forefoot and adjacent joints than the whole lateral TMT joints arthrodesis. The isolated 4^th TMT joint arthrodesis has the lowest influence on the pressure of forefoot and adjacent joints.

Surgical Management Navicular and Cuboid Fractures

The tarsal navicular is a critical component of the foot's medial longitudinal arch. Injuries to the navicular have significant long-term functional consequences. In addition to stress fractures, acute injuries to the navicular include acute avulsion, tuberosity, and body fractures. Nonoperative treatment is the mainstay for avulsion injuries and nondisplaced body fractures. Open reduction and internal fixation is performed to achieve anatomic reduction in the other situations. Common complications following operative intervention include pain, stiffness, post-traumatic arthritis, avascular necrosis, nonunion, and hindfoot deformity. This article provides an overview for recognition and treatment of common presentations of these injuries as described in the literature.

Concurrent Lateral Dorsal Cutaneous and Deep Peroneal Intraneural Ganglion Cysts in the Foot

Intraneural ganglion cysts are non-neoplastic collections of mucinous material within the epineurium of peripheral nerves. We present a rare case of 2 intraneural ganglion cysts in separate nerves of the foot, originating from different joints within the same joint complex. Our findings add to the large body of evidence supporting the unifying articular (synovial) theory. We emphasize the importance of delineating the cyst morphology and origins using high-resolution magnetic resonance imaging before surgery and searching for and resecting the articular branch or branches during surgery.