Screw fixation compared with suture-button fixation of isolated Lisfranc ligament injuries

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Panchbhavi, Vinod K.¹; Vallurupalli, Santaram¹; Yang, Jinping¹; Andersen, Clark R.¹

Screw fixation compared with suture-button fixation of isolated Lisfranc ligament injuries

J Bone Joint Surg. 2009;91A(5):1143-1148

Affiliations

¹The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0165
Abstract

Background: A cannulated screw is currently used to reduce and stabilize diastasis at the Lisfranc joint. The screw requires removal and may break in situ. A suture button does not have these disadvantages, but it is not known if it can provide stability similar to that provided by a cannulated screw or an intact Lisfranc ligament. The objective of the present study was to compare the stability provided by a suture button with that provided by a screw when used to stabilize the diastasis associated with Lisfranc ligament injury.

Methods: Fourteen fresh-frozen, paired cadaveric feet were dissected to expose the dorsal region. A registration marker triad consisting of three screws was fixed to the first cuneiform and the second metatarsal. A digitizer was utilized to record the three-dimensional positions of the registration markers and their displacement in test conditions before and after cutting of the Lisfranc ligament and after stabilization of the joint with either a suture button or a cannulated screw. The first and second cuneiforms and their metatarsals were removed, and the ligament attachment sites were digitized. Displacement at the Lisfranc ligament and the three-dimensional positions of the bones were determined.

Results: Loading with the Lisfranc ligament cut resulted in displacement that was significantly different from that after screw fixation (p = 0.0001), with a difference between means of 1.2 mm. Likewise, loading with the Lisfranc ligament cut resulted in a displacement that was significantly different from that after suture-button fixation (p = 0.0008), with a difference between means of 1.00 mm. No significant difference in displacement was found between specimens fixed with the suture button and those fixed with the screw.

Conclusions: Suture-button fixation can provide stability similar to that provided by screw fixation in cadaver specimens after isolated transection of the Lisfranc ligament.

Clinical Relevance: Fixation with a suture button may be an acceptable alternative to screw fixation in the treatment of isolated Lisfranc ligament injuries, avoiding subsequent surgery to remove the hardware prior to weight-bearing.
Links

DOI: 10.2106/JBJS.H.00162

PubMed: 19411463

WoS: 000265754500014

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