Foot fractures in polytrauma patients: Injury characteristics and timing of diagnosis

Background: Due to prioritizing care and concomitant injuries, foot fractures in polytrauma patients often receive limited attention initially. However, as foot function is important, treatment and diagnosis of these fractures should be accurate. The aims of this study were to assess the incidence and distribution of foot fractures in polytrauma patients and to examine possible risk factors for delayed diagnosis of foot fractures. Methods: This was a retrospective study on all adult (≥18 years) polytrauma (ISS ≥16) patients admitted to a single level 1 trauma center between 2006 and 2016. Patients with foot fractures were identified by diagnosis codes. Data on demographics and trauma characteristics were collected from the Trauma Quality Improvement Program (TQIP^®) database. Data on foot fractures were gathered from electronic patient documentation. Results: Out of 4409 polytrauma patients, 221 (5.0%) sustained a total of 511 foot fractures. Metatarsal fractures were most common (41%), followed by calcaneal (17%), and talar (16%) fractures. Thirty percent of the fractures in 33% of all patients were diagnosed in a delayed fashion. This had treatment consequences in 8%. Delayed diagnosed fractures were more common in older patients (p 0.025), patients with a higher ISS (p 0.012), ICU admission (p 0.015), and concomitant head injury (p 0.020). Conclusions: As one in twenty polytrauma patients sustains at least one foot fracture and a substantial amount of these fractures are diagnosed in a delayed fashion, physicians, regardless of their specialty, should have a high index of suspicion for injuries of the feet in polytrauma patients.