CME OnDemand: 2022 AOFAS Annual Meeting-Lateral Column Midfoot Injury: Do They All Need Fixation?

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This study aimed to analyze lateral column injuries in the midfoot and determine the need for fixation. The researchers conducted a retrospective observational study of 409 feet with midfoot fracture/dislocations. They found that out of the 409 cases, 235 were diagnosed with a lateral column injury, with a significant association with central column injury. Additionally, 70% of lateral column injury cases also had an additional medial column injury.<br /><br />Of the 235 lateral column injuries, data on fixation radiographic alignment was available for 222 cases. The study found that 44 cases underwent Kirschner wire fixation, 23 underwent plate fixation, and 3 underwent screw fixation. The average time to the final radiograph was 77.52 weeks. The study concluded that lateral column injury occurs in over half of midfoot fractures, often in combination with three-column injuries. After stabilizing the central column, additional fixation of lateral column injuries did not appear beneficial. However, in cases where lateral column stabilization was required, Kirchner wires were found to be unlikely beneficial. The use of a bridge plate to fix the central column appeared to be protective. Purely ligamentous injury was found to be a higher risk than an injury that included the bone.<br /><br />Univariate and multivariate regression analysis was conducted to identify possible factors leading to the loss of lateral column alignment at the final radiograph. The use of a bridge plate to fix the central column was found to be protective, and purely ligamentous injury was found to be a higher risk compared to an injury that involved the bone.<br /><br />In conclusion, this study suggests that lateral column injuries are common in midfoot fractures but rarely occur alone. After stabilizing the central column, additional fixation of lateral column injuries may not be beneficial in most cases. The use of a bridge plate to fix the central column appears to be protective, and purely ligamentous injuries pose a higher risk than bone injuries. Further research is needed to validate these findings and optimize treatment approaches for lateral column injuries in the midfoot.

Asset Subtitle

Lyndon W. Mason, MB BCh, MRCS(Eng), FRCS(TR&Orth), FRCS(Glasg), Grace L. Airey, Jitendra Mangwani, MBBS, MS(Orth), FRCS(Tr&Orth), Hiro Tanaka, MD, James Chapman, Mamdouh M. Elbannan

Keywords

lateral column injuries

midfoot

fixation

retrospective observational study

fracture/dislocations

central column injury

medial column injury

Kirschner wire fixation

plate fixation

screw fixation