Irreducible tarsometatarsal fracture-dislocation.

Three mechanisms may prevent closed manipulative reduction of the tarsometatarsal fracture-dislocation: anterior tibialis tendon interposition, incongruity of the medial cuneiform-first metatarsal articulation, and interposition of a fracture fragment in the second metatarsal-intermediate cuneiform joint. Awareness of these mechanisms will assist in the surgical approach to athe irreducible tarsometatarsal fracture dislocation. Such an irreducible fracture-dislocation in a 25-year-old male was successfully reduced openly: anatomic reduction and normal passive range of ankle motion resulted. The patient had a slightly painful midfoot during walker ambulation 10 weeks postinjury.