title: The use of locking plates in complex midfoot fractures.
abstract: BACKGROUND
  Complex fracture dislocations of the midfoot are uncommon. Improved outcomes have been demonstrated where it has been possible to restore and maintain the length and alignment of the medial column as well as the congruity of the articular surfaces. We present our experience  with the use of angle-stable locking plates in the stabilisation of complex midfoot fracture dislocations.
  
  
  METHODS
  Twelve patients were identified on a prospective trauma database between 2003 and 2009. All fractures involved the medial column with four associated fracture subluxations  of the lateral column also. Patients underwent open reduction internal fixation (ORIF) with restoration of the medial column axis, reduction of the articular surface congruity and stabilisation with angle-stable locking plates.
  
  
  RESULTS
  There were no post-operative infections or neurological  injuries. Ten of the twelve patients required metalwork removal. There were no implant failures prior to removal of the metalwork. At a mean follow-up of 12.4 months (range: 4-32 months), 11 patients had minimal symptoms of swelling, discomfort or stiffness in the midfoot. This did not  restrict their daily activities. One patient developed post-traumatic arthritis and collapse of the medial longitudinal arch. Two patients declined removal of the metalwork.
  
  
  CONCLUSIONS
  Angle-stable locking plates provide satisfactory stabilisation following ORIF of complex midfoot fracture  dislocations. Most patients will require removal of the metalwork. Following removal of metalwork, the majority of patients will maintain the length, alignment and stability of the midfoot.
authors.affiliation: King's Mill Hospital, Mansfield Road Sutton in Ashfield, Nottinghamshire NG17 4JL, UK. edbayley12@gmail.com
authors.forename: E
authors.initials: E
authors.lastname: Bayley
authors.forename: N
authors.initials: N
authors.lastname: Duncan
authors.forename: A
authors.initials: A
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D002111:Calcaneus / Q000293:injuries / Q000601:surgery; D020878:Device Removal; D005260:Female; D018409:Foot Injuries / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050723:Fractures, Bone / Q000601:surgery*; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D013639:Tarsal Bones / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome