• van der Vliet Quirine M J QMJ University Medical Center Utrecht, Department of Surgery Utrecht, the Netherlands. Electronic address: q.m.j.vandervliet@umcutrecht.nl., Thirza A Esselink, Marilyn Heng, Roderick M Houwert, Leenen Luke P H LPH University Medical Center Utrecht, Department of Surgery Utrecht, the Netherlands. Electronic address: l.p.h.leenen@umcutrecht.nl., and Falco Hietbrink.
• University Medical Center Utrecht, Department of Surgery Utrecht, the Netherlands. Electronic address: q.m.j.vandervliet@umcutrecht.nl.
• Injury. 2018 Nov 1; 49 (11): 2087-2092.

IntroductionMidfoot injuries are rare injuries, often the result of high-energy trauma and occurring in the context of multiple trauma. This study aimed to evaluate functional outcomes and health-related quality of life after open reduction and internal fixation for midfoot injuries at a level 1 trauma center treating complex foot injuries.MethodsRetrospective single level 1 center study with follow-up by questionnaire. All adult patients who underwent open reduction and internal fixation (ORIF) for Lisfranc and/or Chopart injuries between 2000 and 2016 were included and invited to complete the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score, the EuroQOL Visual Analog Scale (EQ-VAS), and the EuroQOL five-dimensional questionnaire (EQ-5D-5L). Chart reviews were performed to collect demographic, injury, and treatment characteristics.ResultsForty patients with 45 midfoot injuries were included. Follow-up was available for 29 patients (31 feet), leading to a response rate of 83%. The majority of patients suffered high-energy trauma and nearly all patients had a concomitant injury. Secondary arthrodesis was performed in 7/45 injuries. Median AOFAS score was 64 (IQR 47-78). Higher injury severity score (ISS) was associated with poorer functionality as measured with the AOFAS Midfoot Score (p =  0.046), concomitant injuries were associated with lower quality of life (p = 0.01). EQ-5D scores were significantly lower when compared to the Dutch reference population (p< 0.001).ConclusionsInjuries of the midfoot have negative effects on mid- to long-term quality of life after trauma, with considerable potential for long-term impaired functionality. When counseling patients with these rare injuries after high-energy trauma mechanisms or in the context of multiple trauma, realistic expectations on postoperative recovery should be given.Copyright © 2018 Elsevier Ltd. All rights reserved.

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