Diacon A L, Kimmel L A, Hau R C, Gabbe B J, Edwards E R
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Physiotherapy, The Alfred Hospital, Melbourne, Australia.
Injury. 2019 Feb;50(2):558-563. doi: 10.1016/j.injury.2018.11.021. Epub 2018 Nov 12.
Multitrauma patients suffering hindfoot fractures, including calcaneal and talar fractures, often result in poor outcomes. However, less is known about the outcomes following midfoot fracture in the mutitrauma population. This study aims to describe the epidemiology of midfoot fractures in multitrauma patients and to compare the outcomes of midfoot and hindfoot fractures in this population.
Data about multitrauma patients (Injury Severity Score >12) sustaining a unilateral midfoot or hindfoot fracture were obtained from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and from retrospective review of medical records at a major trauma centre. Further outcome data were obtained via a survey using the American Academy of Orthopedic Surgeons Foot and Ankle Score (AAOS FAS) and the 12-item Short Form Health Survey (SF-12).
122 multitrauma patients were included; 81 with hindfoot fractures and 41 with midfoot fractures. The median ISS (IQR) was 22 (17-29) and 27 (17-24) for the hindfoot and midfoot groups, respectively (p = 0.23). Hindfoot and midfoot fractures were commonly associated with intracranial injuries (80.3%), spine injuries (60.7%), ipsilateral lower extremity injuries (24.6%) and pelvic injuries (16.4%). The mean (SD) time to follow up was 4.5 (±2.7) years. There were no differences in mean SF-12 physical (37.97 vs 35.22, p = 0.33) or mental (46.90 vs 46.67, p = 0.94) component summary scores between the groups. There were no differences in mean AAOS FAS standard scores (69.3 vs 69.1, p = 0.97) or shoe comfort scores (median 40 vs 40 p = 0.18) between the groups.
Functional outcomes in multitrauma patients with midfoot or hindfoot fractures were comparable. These findings suggest that midfoot fractures should be treated with the same degree of due diligence as hindfoot fractures in the multitrauma patient.
遭受后足骨折（包括跟骨和距骨骨折）的多发伤患者往往预后不佳。然而，对于多发伤人群中足中部骨折后的预后情况，人们了解得较少。本研究旨在描述多发伤患者中足中部骨折的流行病学特征，并比较该人群中足中部骨折和后足骨折的预后。
从维多利亚州骨科创伤结局登记处（VOTOR）以及对一家主要创伤中心的病历进行回顾性分析，获取有关单侧中足或后足骨折的多发伤患者（损伤严重度评分>12）的数据。通过使用美国矫形外科医师学会足踝评分（AAOS FAS）和12项简短健康调查问卷（SF-12）进行的一项调查，获取进一步的结局数据。
纳入122例多发伤患者；81例为后足骨折，41例为中足骨折。后足组和中足组的损伤严重度评分中位数（四分位间距）分别为22（17 - 29）和27（17 - 24）（p = 0.23）。后足骨折和中足骨折通常与颅脑损伤（80.3%）、脊柱损伤（60.7%）、同侧下肢损伤（24.6%）和骨盆损伤（16.4%）相关。平均（标准差）随访时间为4.5（±2.7）年。两组之间的SF-12身体成分总结评分（37.97对35.22，p = 0.33）或精神成分总结评分（46.90对46.67，p = 0.94）无差异。两组之间的AAOS FAS标准评分（69.3对69.1，p = 0.97）或鞋舒适度评分（中位数40对40，p = 0.18）无差异。
多发伤患者中足中部或后足骨折的功能预后相当。这些发现表明，在多发伤患者中，对中足骨折应与后足骨折一样给予同等程度的认真治疗。
