Pattern of injury in polytrauma compared to single limb related Lisfranc joint fractures

Midfoot fractures in polytrauma patients are often an underappreciated injury relative to their other major injuries sustained. In this study, our aim was to explore the mechanisms and patterns of injury in polytrauma related midfoot fractures as compared to single limb injuries.

Multicentre observational study.

Data was retrospectively collected from four centres (two major trauma centres and two trauma units) on surgically treated midfoot fracture dislocations between 2011 and 2021. Polytrauma was defined as a patient presenting with an Injury Severity Score (ISS) threshold of 15 or greater. Radiographs were analysed using departmental PACS. All statistics were performed using SPSS 26.

A total of 410 cases were included in the study. The rate of unstable midfoot injury was similar to simple falls, falls from height, crush injury, assault, sport and seizure. The only mechanisms that differ are a higher rate of midfoot injury in non-polytrauma patients undergoing a simple fall (19.71% vs. 6.78%) and higher rates of midfoot injury in polytrauma patients following motor vehicle collision (16.86% vs. 33.90%). Regarding patterns of injury, there was a significant increase in number of columns injured in polytrauma patients (polytrauma patient 3 column injury 77.97%, non-polytrauma patient 3 column injury 34.00%). There was no difference in the prevalence of central column injury (p = .623), although there were significantly more medial and lateral column injuries in the polytrauma group (p < .001 for both).

Polytrauma related Lisfranc joint midfoot injuries have a higher prevalence of medial and lateral column injury than non-polytrauma Lisfranc joint midfoot injuries. Non-polytrauma injuries can, however, have an equally significant force involved as polytrauma patients, with over 50% occurring as the result of high velocity injury. A high index of suspicion should be maintained for midfoot injuries in high velocity mechanisms, regardless of other injuries sustained.