Lateral column midfoot injury: Do they all need fixation?

Area of Science:

• Orthopedic Surgery
• Traumatology
• Foot and Ankle Surgery

Background:

• Midfoot injuries often focus on the central column and Lisfranc ligament, with less evidence on lateral column injuries.
• Historically, lateral column injuries were treated with Kirschner wire fixation.

Purpose of the Study:

• To analyze midfoot lateral column injuries and evaluate their treatment methods.
• To investigate the outcomes of different fixation techniques for lateral column injuries.

Main Methods:

• A multicenter observational study retrospectively collected data from 2011-2021 on surgically treated midfoot fracture dislocations.
• Radiographs were analyzed using PACS, and statistical analysis was performed using SPSS 26.

Main Results:

• Out of 409 midfoot injuries, 235 involved the lateral column, often with central (99.6%) and medial (70.6%) column involvement.
• Most lateral column injuries (63%) did not require fixation, with low rates of alignment loss (2.84%). Kirschner wire fixation showed a higher alignment loss rate (5.88%) compared to plates and screws.
• Bridge plating of the central column appeared protective, and purely ligamentous injuries posed a higher risk than bone injuries.

Conclusions:

• Lateral column injuries constitute over half of midfoot fractures in this study, typically associated with multi-column injuries.
• Following central column stabilization, additional fixation for lateral column injuries is often not required.
• When lateral column stabilization is necessary, plates and screws may offer better outcomes than Kirschner wires.