Hello, thank you for choosing to watch our audio recorded presentation looking at the pattern of injury in polytrauma compared to single limb related midfoot fractures. Midfoot fractures in polytrauma patients are often an unappreciated injury relative to their other major injuries sustained. The management of midfoot fractures may differ with timing and methods of intervention in the context of polytraumatised patients. Fan et al. assessed the surgical outcomes of Lisfranc injuries accompanied by multiple metatarsal fractures where they either underwent surgical fusion or fixation, concluding that surgical fusion results in better outcome than non-fusion in the treatment of Lisfranc injuries accompanied by multiple metatarsal fractures. Kadao et al. reviewed the safety and efficacy of managing high energy input fracture dislocations with interval external fixation prior to definitive open reconstruction in a polytraumatised patient. Arberg et al. reviewed the incidence of total and delayed foot fracture diagnosis in polytraumatised patients and the outcomes associated with a delayed diagnosis. The table on the right details the location of the fractures sustained and the percentage of those diagnosed late. There is a high percentage of metatarsal injuries sustained, and of those fracture locations with a delayed diagnosis, cuboid and metatarsal fractures have the highest frequency. This was an observational study to explore the mechanisms and patterns of injury in polytrauma related midfoot fractures compared to single limb injuries. Four centres were included, incorporating two level 1 major trauma centres and two level 2 trauma units. Data was collected retrospectively on surgically treated midfoot fracture dislocations over a 10 year period. Radiographs were analysed using the departmental PACS and statistics performed using SPSS. Patient imaging was reviewed and injuries grouped according to the location of the injury in relation to the affected column, the number of columns involved and the severity of the injury. A total of 409 patients were included in this study. Patients were categorised according to their presence of polytrauma or not, whereby 14.4% sustained polytrauma. Of these totals, patients were further subcategorised according to the mechanism of injury detailed on the row above, including 17.8% of patients having an unknown mechanism. This table highlights that most polytrauma was sustained by a motor vehicle collision. Injuries were also subcategorised according to the number of columns injured. 1 or 2 column injuries were more frequently encountered in the absence of polytrauma, whereas 77.97% of 3 column injuries were associated with polytrauma. Looking closer at the columns affected in the presence or absence of polytrauma, there are statistically more medial column and lateral column injuries in polytrauma patients. There were statistically more bony injuries compared to pure ligamentous injuries in the polytrauma group. Key points from this study. Motor vehicle collision was the only mechanism of injury with a higher frequency in polytrauma patients compared to single limb injuries. Polytrauma patients had a significant increase in the number of columns affected. There was a significant increase in the number of lateral column and medial column injuries in the polytraumatised patient. Finally, polytrauma patients are unlikely to have a pure ligamentous injury.

polytrauma

midfoot fractures

management

surgical outcomes

columns affected