Abstract
Introduction
Comminuted mid-foot fractures are uncommon. Maintenance of the length and alignment of the medial column, with restoration of articular surface congruity, is associated with improved outcomes. Conventional surgery has utilised open or closed reduction with K-wire fixation, percutaneous techniques, ORIF, external fixation or a combination of these methods.
In 2003 temporary bridge plating of the medial column was described to reconstruct and stabilise the medial column. The added advantage of locking plates is the use of angle-stable fixation. We present our experience with temporary locking plates in complex mid-foot fractures.
Materials and methods
Prospective audit database of 12 patients over a 6 year period (2003-2009).
5 males 7 females mean age 41.9.
Mechanism of injury: 11 high-energy injuries (6 falls from height, 5 RTCs), 1 low energy injury. Fracture type: All involved the medial column - 12 fracture dislocations of the medial column.
4 concomitant injuries to the lateral column.
All underwent ORIF, realignment, and stabilisation with locking plates across the mid-foot.
Results
Median length of time to plate removal: 3 months (range 2-6).
Prior to removal of the metalwork, there was no loss of reduction, no infections, and no implant breakage.
10 out of 12 required plate removal at 3 months.
Long-term follow-up (Mean 12.4 months, range 4-32): 11 have minimal symptoms of swelling or discomfort from the midfoot which does not restrict their ADLs, whilst 1 patient developed post-traumatic arthritis with medial arch collapse. No secondary procedures following plate removal.
The two patients with the plate in-situ were asymptomatic with regards to the metalwork at final follow-up.
Conclusion
Locking plates provide adequate stabilisation following open reduction and internal fixation of complex and unstable midfoot fracture dislocations. However, the majority will require removal of the metalwork.
Following removal of the metalwork, satisfactory length and alignment, and stability of the midfoot, is maintained.
