Dislocations of the Metatarsal Bone and Adjacent Toe.

Severe injuries to the forefoot are less in the mid-twentieth century than in Lisfranc’s equestrian age. Out of 1 1,000 patients treated for fracture at the Royal Infirmary, Edinburgh, only twenty-four (0 2 per cent) sustained fracture-dislocations or multiple fractures involving the metatarsal bones. These injuries are the result of combined bending, compressing and twisting forces in one or several directions to the whole or part of the forefoot, and the precise mechanism of injury has been widely discussed (Lisfranc 1840; Gissane 1951 ; Watson-Jones 1955; del Sel i955; Key and Conwell 1956; Collett, Hood and Andrews 1958; Granberry and Lipscomb 1962; Aitken and Poulson 1963; Jeifreys 1963). It is not intended to undertake a further analysis at this stage but to present two similar cases of a type not previously reported, the mechanics of which seem to be pertinent in arriving at a workable classification of these injuries. The phenomenon of the linked toe in dislocations of the tarso-metatarsal joints is described in relation to these two cases and the concept of segmental injuries to the forefoot is introduced.