Lateral column midfoot injury: Do they all need fixation?

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2024-10-09 DOI:10.1016/j.jor.2024.10.010

Thomas R.W. Ward , Khalis Boksh , Grace Airey , Darren Myatt , Junaid Aamir , James Chapman , Htin Kyaw , Lucky Jeyaseelan , Lauren Greasley , Isabella Drummond , Mamdouh Elbannan , Hiro Tanaka , Jitendra Mangwani , Lyndon Mason

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Abstract

Introduction/purpose

Research on midfoot injuries have primarily concentrated on the central column and the Lisfranc ligament without amassing evidence on lateral column injuries. Classically lateral column injuries were treated with Kirschner wire fixation. Our aim was to analyse midfoot lateral column injuries and their methods of treatment.

Methods

Multicentre observational study. 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 409 surgically treated midfoot injuries were identified for further investigation. Following analysis, a total of 235 cases were diagnosed as having a lateral column injury, and 222 had data available for further analysis. All but 1 case (234, 99.6 %) of lateral column injury was associated with central column injury and 166 cases (70.6 %) were associated with medial column injuries.

There were 44 cases where the lateral column underwent Kirschner wire fixation, 23 lateral column plate fixations and 3 lateral column screw fixations. Most patients (147, 63 %) had no fixation for their lateral column injury with only 2.84 % losing alignment at subsequent follow up. The patients undergoing K wire fixation had a greater loss of alignment rate (5.88 %). The use of a bridge plate to fix the central column appears protective and purely ligamentous injury was a higher risk than an injury that included the bone.

Conclusion

Lateral column injury occur in over half of midfoot fractures in this study. It rarely occurs alone and is most commonly related to three column injuries. Nevertheless, following stabilisation of the central column, additional fixation of injuries to the lateral unlikely to be required in the majority of cases. In cases where lateral column stabilisation is required, plates and screws may be preferable to K wires.

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中足外侧柱损伤：是否都需要固定？

引言/目的有关中足损伤的研究主要集中在中柱和Lisfranc韧带，而没有积累有关外侧柱损伤的证据。外侧骨柱损伤通常采用 Kirschner 钢丝固定治疗。我们的目的是分析中足外侧柱损伤及其治疗方法。从三个中心回顾性收集了2011年至2021年期间手术治疗中足骨折脱位的数据。利用科室的 PACS 对射线照片进行分析。所有数据均使用 SPSS 26 进行统计。经过分析，共有 235 个病例被诊断为外侧柱损伤，其中 222 个病例的数据可供进一步分析。除1例（234例，99.6%）外，所有外侧骨柱损伤均伴有中央骨柱损伤，166例（70.6%）伴有内侧骨柱损伤。大多数患者（147 例，63%）的外侧柱损伤没有进行固定，只有 2.84% 的患者在后续随访中失去了对位。接受K线固定的患者对位丧失率更高（5.88%）。使用桥接钢板固定中央骨柱似乎具有保护作用，纯粹的韧带损伤比包括骨骼在内的损伤风险更高。在这项研究中，半数以上的中足骨折发生了外侧骨柱损伤，这种损伤很少单独发生，通常与三根骨柱损伤有关。尽管如此，在稳定中央骨柱后，大多数情况下不太可能需要额外固定外侧骨柱损伤。在需要稳定外侧支柱的病例中，钢板和螺钉可能优于K线。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.