title: Staged treatment of high energy midfoot fracture dislocations.
abstract: BACKGROUND
  Staged care with interval external fixation is a successful established treatment strategy for high energy periarticular fractures with often extensive soft tissue damage such as the tibial plateau and plafond. The aim of the current study was to determine whether staged care of high energy midfoot fracture/dislocation with interval external fixation prior to definitive open reconstruction in the polytraumatized patient was both safe and efficacious.
  
  
  METHODS
  One hundred twenty-three patients were operated on for high energy midfoot fracture/dislocation during the 8-year study period. Eighteen polytrauma patients were selectively treated with a staged protocol. Radiographic assessment was utilized to determine if the fixator achieved gross skeletal alignment. Further, final alignment after definitive reconstruction and postoperative complications were analyzed.
  
  
  RESULTS
  The fixator improved both length and alignment of all high energy midfoot fracture/dislocations. Loss of acceptable reduction while in the temporary frame occurred in only 1 case. Final alignment after definitive reconstruction was anatomic in all cases. No cases of wound-related complication and/or deep infection occurred.
  
  
  CONCLUSIONS
  Delayed reconstruction of high energy midfoot fracture/dislocation using interval external fixation should be an accepted care paradigm in selected polytrauma patients.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Tiffany R
authors.initials: TR
authors.lastname: Kadow
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Siska
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Evans
authors.affiliation: Integris Orthopedic Central, Oklahoma City, OK, USA.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Sands
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA tarkinis@upmc.edu.
authors.forename: Ivan S
authors.initials: IS
authors.lastname: Tarkin
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D005545:Forefoot, Human / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Lisfranc; crush injury; external fixation; fracture dislocation; midfoot