• C Kösters, S Bockholt, C Müller, C Winter, D Rosenbaum, M J Raschke, and S Ochman.
• Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital, University of Muenster, Albert Schweitzer Campus 1, Building W1, 48149, Muenster, Germany, clemens.koesters@ukmuenster.de.
• Arch Orthop Trauma Surg. 2014 Oct 1; 134 (10): 1397-404.

ObjectivesComplex midfoot injuries could lead to severe functional impairment of mobility and quality of daily living. Aim of this study was to compare the clinical and functional outcomes of Chopart, Lisfranc fractures and multiple metatarsal shaft fractures.DesignRetrospective case series.SettingLevel one trauma center.InterventionOpen or closed reduction and internal fixation with screws, K-wires, plates, external fixation or combination of different technics.Main Outcome MeasurementsThe American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score and the Maryland Foot Score were used to assess pain and functional outcome. 3D gait analysis, pedobarographic analysis and radiologic examinations were performed. The activity level was measured by a step counting accelerometer. All results were compared to an age-matched healthy control group.Results24 patients with a median age of 44 years (16-72) were included: 12 patients with multiple metatarsal shaft fractures, 6 patients with Chopart and 6 patients with Lisfranc fractures. The median follow-up was 2.6 years. The pedobarographic analysis reports reduced contact time of the total foot (p = 0.08), the forefoot (p = 0.008) and the hallux (p = 0.015) for the injured foot. A median score of 64 for the SF-36, 64 for the AOFAS Midfoot Score and 73 for the Maryland Foot Score indicated a poor restoration of foot function. Multiple metatarsal shaft fractures presented a significantly lower walking speed (p = 0.03) and cadence (p = 0.04).ConclusionThe worst results were reported for multiple metatarsal shaft fractures on outcome scores, pedobarography, gait analysis and activity. Metatarsal serial fractures should not be underestimated as well as Chopart and Lisfranc fractures.Level Of EvidenceLevel IV.

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