Lateral column midfoot injury: Do they all need fixation?

Introduction/purpose: Research on midfoot injuries have primarily concentrated on the central column and the Lisfranc ligament without amassing evidence on lateral column injuries. Classically lateral column injuries were treated with Kirschner wire fixation. Our aim was to analyse midfoot lateral column injuries and their methods of treatment.

Methods: Multicentre observational study. Data was retrospectively collected from three centres on surgically treated midfoot fracture dislocations between 2011 and 2021. Radiographs were analysed using departmental PACS. All statistics was performed using SPSS 26.

Results: A total of 409 surgically treated midfoot injuries were identified for further investigation. Following analysis, a total of 235 cases were diagnosed as having a lateral column injury, and 222 had data available for further analysis. All but 1 case (234, 99.6 %) of lateral column injury was associated with central column injury and 166 cases (70.6 %) were associated with medial column injuries.There were 44 cases where the lateral column underwent Kirschner wire fixation, 23 lateral column plate fixations and 3 lateral column screw fixations. Most patients (147, 63 %) had no fixation for their lateral column injury with only 2.84 % losing alignment at subsequent follow up. The patients undergoing K wire fixation had a greater loss of alignment rate (5.88 %). The use of a bridge plate to fix the central column appears protective and purely ligamentous injury was a higher risk than an injury that included the bone.

Conclusion: Lateral column injury occur in over half of midfoot fractures in this study. It rarely occurs alone and is most commonly related to three column injuries. Nevertheless, following stabilisation of the central column, additional fixation of injuries to the lateral unlikely to be required in the majority of cases. In cases where lateral column stabilisation is required, plates and screws may be preferable to K wires.