Etiology, treatment and long-term results of isolated midfoot fractures

PurposeEtiology, treatment and long-term results of patients with isolated midfoot fractures were evaluated to create a basis for treatment optimization.MethodInjury cause, type and extent, treatment and long-term results (American Association of Foot and Ankle Surgery-Midfoot-Score (AOFAS-M), Hannover Scoring System (HSS), own Questionnaire (Q)) of isolated midfoot fractures (avulsions and Chopart/Lisfranc fracture dislocations excluded) were determined.ResultsFifty-eight patients with isolated midfoot fractures were included. Injury causes were vehicular trauma (n = 40), falls (n = 13), contusions (n = 3) and others (n = 2). The fractures were located as follows: cuboid, n = 28; naviculare, n = 23; cuneiforme I, n = 19; cuneiforme II, n = 11; and cuneiforme III, n = 9. 91.4% (n = 53) of cases were treated operatively, 15 times with closed and 38 times with open reduction. Five patients were treated conservatively.Forty-seven (81.0%) patients had follow-up after 9 (1–22) years. The mean follow-up scores of the entire group were AOFAS-M = 66.7, HSS = 62.8, and Q = 62.2. No significant score differences were determined with regard to age, sex, and time or type of treatment. The highest scores were observed in non-displaced fractures or after early anatomic reduction.ConclusionIsolated midfoot fractures without Chopart's or Lisfranc's joint fracture dislocation are uncommon. The long-term results are mostly characterized by minimal functional restrictions. In cases with poor results, the initial restoration of anatomic conditions have been unsatisfactory. Therefore, we recommend the early reduction and internal fixation in all displaced fractures. The reduction should be open if the closed reduction does not achieve anatomic conditions.