Pattern of Injury in Polytrauma Compared to Single Limb Related Midfoot Fractures

Abstract

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Midfoot fractures in polytrauma patients are often an under appreciated injury relative to their other major injuries sustained. In this study, our aim was to explore the mechanisms and patterns of injury in a polytrauma related midfoot fractures as compared to single limb injuries. Methods: Setting: Multicentre observational study Methods: Data was retrospectively collected from three centres on surgically treated midfoot fracture dislocations between 2011 and 2021. Radiographs were analysed using departmental PACS. All statistics was performed using SPSS 26. Results: A total of 212 cases were included in the study. Almost all polytrauma cases had occurred as the result of a fall from height or road traffic collision (RTC) (19/20). In single limb injuries, 32% (61/192) had also occurred as the result of fall from height or RTC. The most common mechanism for single limb midfoot fracture was a trip (79/192). Crush injuries only occurred in the single limb injury group in our cohort (n=21). Regarding patterns of injury, there was no significant difference in prevalence of medial column injury (p=.260), or central column injury (p=.704). There were significantly more lateral column injuries in the polytrauma group (75% vs 44%, p=.008), and the polytrauma group was exclusively fracture related compared to 17% of single limb injury having purely ligamentous injury (p=.047). Conclusion: Polytrauma related midfoot injuries have a higher prevalence of lateral column injury than the single limb injuries. Single limb injuries can however, have an equally significant force involved as polytrauma patients with over 50% occurring as the result of high velocity injury. A high index of suspicion should be maintained for midfoot injuries in high velocity mechanisms, regardless of other injuries sustained.