Article
Long-Term Functional Outcome of Midfoot Fractures
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Authors
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C. Jones
- Orthopaedic Associates of Michigan, Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, Michigan, United States
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D. Sietsema
- Orthopaedic Associates of Michigan, Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, Michigan, United States
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J. Ringler
- Orthopaedic Associates of Michigan, Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, Michigan, United States
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T. Endres
- Orthopaedic Associates of Michigan, Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, Michigan, United States
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M. Coulibaly
- Michigan State University, College of Human Medicine, Department of Surgery, Orthopaedic Research Fellowship, GRMERC, Grand Rapids, Michigan, United States
| Published: | October 21, 2010 |
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Outline
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Objective: Midfoot fractures (MF) are uncommon. The purpose of this study was to evaluate functional outcome in patients treated for MF fractures.
Methods: A prospective analysis was undertaken on a cohort of patients diagnosed with MF between March 2002 and June 2007 at a Level I teaching trauma center. Out of a total of 129 patients 62 patients with 65 treated MF returned valid questionnaires. Primary outcome was to evaluate functional status (Foot Function Index [FFI] and Short Musculoskeletal Function Assessment [SMFA]).
Results and conclusions: Thirty-two males and 30 females had a mean age of 44±14 years (range 17–72) and BMI 28.0 (range 17.5–48.9). Mechanism of injury was 31 road accidents (MVA/MCA/ATV), 9 crush injuries, 9 low-energy falls, 9 twist, and 4 high-energy falls or sport-related injury. Survey follow-up time averaged 53±20 mo (range 23–93). Based on presence of cuboid and navicular fractures patients were grouped into lateral column injury (LAT, 26/65, 40.0%), medial column injury (MED, 19/65, 29.2%), or bicolumn injury (BIC, 20/65, 30.8%) groups. Average functional status scores were FFI 31.1, Daily 21.8, Emotional 31.5, Arm-Hand 6.8, Mobility 29.0, Dysfunction 23.0, and Bother 24.2. BIC performed significantly worse than MED for all functional scores except Arm-Hand (p<0.05) and worse than LAT in FFI (p=0.007). BIC related to inferior functional scores (FFI r=0.419; SFMA Daily r=0.389, Mobility r=0.362, and Dysfunction r=0.341) with significance at p<0.01. The inability to return to previous level of activity was related to inferior functional status (FFI r=–0.424, Daily r=–0.403, Mobility r=–0.404, Dysfunction r=–0.377) with significance at p<0.01. BMI independently contributed to inferior functional scores (FFI R2=0.265, Daily R2=0.405, Emotional R2=0.374, Mobility R2=0.491, Dysfunction R2=0.450, Bother R2=0.493) with significance at p<0.001.
Midfoot fractures are debilitating injuries that remain challenging for the orthopaedic surgeon. Bicolumn injuries of the foot had the worst long-term functional outcome. Increased BMI determined inferior functional status.
