Session VIII - Foot and Ankle

Sunday, October 19, 1997 Session VIII, 10:39 a.m.

Do Foot Injuries Significantly Affect the Functional Outcome of Multiply- Injured Patients?

Emil H. Schemitsch, MD, FRCS(C), Diana C. Turchin, MD, Michael D. McKee, MD, FRCS(C), James P. Waddell, MD, FRCS(C)

St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada

Purpose: To assess the functional outcome of multiply-injured trauma patients with foot injuries and to determine which outcome measures are most appropriate for this assessment.

Conclusion: The SF-36, WOMAC and Boston's Children's Hospital Grading System are all useful in assessing the outcome of multiply-injured patients with foot injuries. The outcome of these patients is poor, using any of these measures.

Significance: Foot injuries cause significant disability to multiply-injured patients. More attention should be given to these injuries, and more aggressive management considered, in an effort to improve the outcome of this group of multiply injured patients.

Discussion: Twenty-eight multiply-injured patients with foot injuries were identified in our prospective trauma database (Group 1). The patients in Group 1 were randomly matched in a blinded fashion to 28 multiply-injured patients without foot injuries who were selected from the entire group of patients in our trauma database (Group 2). The patients were matched by age, sex, length of follow-up, and Injury Severity Score. In each group there were 17 males and 11 females. The mean age in Group 1 was 34 years and in Group 2 was 36 years. The mean ISS was 25 in each group. The mean duration of follow up was 62 months in Group 1 and 70 months in Group 2. The specific foot injuries were: calcaneal fractures (thirteen patients), talar fractures (6 patients), Lisfranc fracture dislocations (4 patients), other midfoot fractures (4 patients), phalangeal fractures (2 patients). Three outcome tools were used: the SF-36, WOMAC, and Boston Childrens' Hospital Grading System. The outcome of multiply-injured patients with foot injuries was significantly worse than that of patients without foot injuries, using any of the three outcome measures (SF-36, p=0.008; WOMAC, p=0.00007; Boston Children's score, p=0.001). The outcome of patients with foot injuries was worse than those without foot injuries in five of the eight components of the SF-36 score (physical functioning, (p=0.0004); role-physical, (p=0.01); bodily pain, (p=0.01); social functioning, (p=0.01); role-emotional, (p=0.006)). The outcome of patients with foot injuries was worse than that of patients without foot injuries in all three components of the WOMAC (pain score, (p=0.0004); stiffness score (p=0.07); physical function score; (p=0.00006)). For the patients with foot injuries, there was strong correlation between all three scales (SF-36 vs. WOMAC: r=0.84, SF-36 vs. Boston Childrens' Hospital: r=0.88, WOMAC vs. Boston Childrens' Hospital: r=0.78).