A Prospective Cohort Study of Closed Foot Injuries in a Tertiary Hospital in Ghana

Abstract

Objective: Our objectives were to determine the proportion of closed foot injuries and their treatment outcomes at a large trauma hospital in Accra, Ghana.
Methods: A structured questionnaire was used to record, for each patient, the type of closed foot injury, the mechanism of injury, any concomitant injuries, the time interval between injury and arrival at the KBTH for treatment as well as the type of treatment instituted.
Enrolled patients were followed up for six months, complications resulting from the foot injury or its treatment were recorded for each patient. The function of the foot after healing of the injury was measured using the American Foot and Ankle Society Score.
Results: A total of 46 patients presented with closed foot injuries, males accounted for 58.7% and females 41.3%. Road traffic trauma was by far the most predominant cause of injury accounting for 63% of cases. Soft tissue contusions involving the foot had excellent outcomes after treatment; displaced metatarsal shaft fractures treated with open reduction and internal fixation with Kwires had a good outcome; displaced metatarsal shaft fractures treated with cast immobilization had unfavorable outcomes. Non-operative treatment of Lanfranc fracture-dislocation with cast immobilization resulted in severe limitation of climbing stairs, shoe wear, walking on uneven surfaces and inability to return to previous occupation.
Conclusions: Displaced intra-articular calcaneal fractures cause significant persistent foot pain after treatment and Lisfranc fracture- islocations have unfavorable outcomes if treated conservatively with cast immobilization alone. Fractures of the foot cause a longterm morbidity with residual foot pain, limitation of foot wear, climbing stairs, walking on uneven surfaces and difficulty integrating into previous occupation. The resulting foot dysfunction is worse if the fracture is not appropriately stabilized.