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

Cited Works (18)

Year	Entry
1999	Miller RS, Weinhold PS, Dahners LE. Comparison of tricortical screw fixation versus a modified suture construct for fixation of ankle syndesmosis injury: a biomechanical study. J Orthop Trauma. January 1999;13(1):39-42.
2008	Panchbhavi VK, Andersen CR, Vallurupalli S, Yang J. A minimally disruptive model and three-dimensional evaluation of Lisfranc joint diastasis. J Bone Joint Surg. 2008;90A(12):2707-2713.
1994	Shapiro MS, Wascher DC, Finerman GAM. Rupture of Lisfranc's ligament in athletes. Am J Sports Med. September–October 1994;22(5):687-691.
2006	Desmond EA, Chou LB. Current concepts review: Lisfranc injuries. Foot Ankle Int. 2006;27(8):653-660.
2007	Lattermann C, Goldstein JL, Wukich DK, Lee S, Bach BR Jr. Practical management of Lisfranc injuries in athletes. Clin J Sport Med. 2007;17(4):311-315.
1995	Englanoff G, Anglin D, Hutson HR. Lisfranc fracture-dislocation: a frequently missed diagnosis in the Emergency Department. Ann Emerg Med. 1995;26(2):229-233.
2008	Panchbhavi VK. Extraarticular stabilization of Lisfranc injury. Tech Foot Ankle Surg. 2008;7(2):100-106.
2001	Kura H, Luo Z-P, Kitaoka HB, Smutz WP, An K-N. Mechanical behavior of the Lisfranc and dorsal cuneometatarsal ligaments: in vitro biomechanical study. J Orthop Trauma. February 2001;15(2):107-110.
2001	Solan MC, Moorman CT III, Miyamoto RG, Jasper LE, Belkoff SM. Ligamentous restraints of the second tarsometatarsal joint: a biomechanical evaluation. Foot Ankle Int. August 2001;22(8):637-641.
2004	Lee CA, Birkedal JP, Dickerson EA, Vieta PA Jr, Webb LX, Teasdall RD. Stabilization of Lisfranc joint injuries: a biomechanical study. Foot Ankle Int. May 2004;25(5):365-370.
2002	Nunley JA, Vertullo CJ. Classification, investigation, and management of midfoot sprains. Am J Sports Med. November–December 2002;30(6):871-878.
1991	Seitz WH Jr, Bachner EJ, Abram LJ, Postak P, Polando G, Brooks DB, Greenwald AS. Repair of the tibiofibular syndesmosis with a flexible implant. J Orthop Trauma. March 1991;5(1):78-82.
2006	Ly TV, Coetzee JC. Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation: a prospective, randomized study. J Bone Joint Surg. 2006;88B(3):514-520.
2005	Alberta FG, Aronow MS, Barrero M, Diaz-Doran V, Sullivan RJ, Adams DJ. Ligamentous Lisfranc joint injuries: a biomechanical comparison of dorsal plate and transarticular screw fixation. Foot Ankle Int. 2005;26(6):462-473.
2002	Mulier T, Reynders P, Dereymaeker G, Broos P. Severe lisfranc injuries: primary arthrodesis of ORIF? Foot Ankle Int. 2002;23(10):902-905.
1989	Myerson M. The diagnosis and treatment of injuries to the Lisfranc joint complex. Orthop Clin North Am. 1989;20(4):655-664.
2000	Kuo RS, Tejwani NC, DiGiovanni CW, Holt SK, Benirschke SK, Hansen ST Jr, Sangeorzan BJ. Outcome after open reduction and internal fixation of Lisfranc joint injuries. J Bone Joint Surg. November 2000;82A(11):1609-1618.
1998	Coss HS, Manos RE, Buoncristiani A, Mills WJ. Abduction stress and AP weightbearing radiography of purely ligamentous injury in the tarsometatarsal joint. Foot Ankle Int. 1998;19(8):537-541.

Cited By (23)

Year	Entry
2014	Hu S-j, Chang S-m, Li X-h, Yu G-r. Outcome comparison of Lisfranc injuries treated through dorsal plate fixation versus screw fixation. Acta Ortop Bras. 2014;22(6):315-320.
2011	Soomekh DJ. New technology and techniques in the treatment of foot and ankle injuries. Clin Podiatr Med Surg. 2011;28(1):19-41.
2015	Lievers WB, Frimenko RE, McCullough KA, Crandall JR, Kent RW. Etiology and biomechanics of midfoot (Lisfranc) injuries in athletes. Crit Rev Biomed Eng. 2015;43(2-3):213-238.
2012	Nery C, Réssio C, Alloza JFM. Subtle Lisfranc joint ligament lesions: surgical neoligamentplasty technique. Foot and Ankle Clinics. September 2012;17(3):407-416.
2010	Brin YS, Nyska M, Kish B. Lisfranc injury repair with the TightRope™ device: a short-term case series. Foot Ankle Int. July 2010;31(7):624-627.
2010	Ahmed S, Bolt B, McBryde A. Comparison of standard screw fixation versus suture button fixation in Lisfranc ligament injuries. Foot Ankle Int. 2010;31(10):892-896.
2011	Pelt CE, Bachus KN, Vance RE, Beals TC. A biomechanical analysis of a tensioned suture device in the fixation of the ligamentous Lisfranc injury. Foot Ankle Int. April 2011;32(4):422-431.
2013	Marsland D, Belkoff SM, Solan MC. Biomechanical analysis of endobutton versus screw fixation after Lisfranc ligament complex sectioning. Foot Ankle Surg. December 2013;19(4):267-272.
2019	Ho NC, Sangiorgio SN, Cassinelli S, Shymon S, Fleming J, Agrawal V, Ebramzadeh E, Harris TG. Biomechanical comparison of fixation stability using a Lisfranc plate versus transarticular screws. Foot Ankle Surg. February 2019;25(1):71-78.
2010	Anderson RB, Hunt KJ, McCormick JJ. Management of common sports-related injuries about the foot and ankle. J Am Acad Orthop Surg. September 2010;18(9):546-556.
2010	Watson TS, Shurnas PS, Denker J. Treatment of Lisfranc joint injury: current concepts. J Am Acad Orthop Surg. December 2010;18(12):718-728.
2017	Shakked RJ. Lisfranc injury in the athlete. JBJS Reviews. September 2017;5(9):e4.
2015	Crates JM, Barber FA, Sanders EJ. Subtle lisfranc subluxation: results of operative and nonoperative treatment. J Foot Ankle Surg. May–June 2015;54(3):350-355.
2014	Kale DR, Khadabadi NA, Putti BB, Jatti RS. One month old neglected Lisfrancs fracture dislocation treated with Wagner's external fixator and percutaneous screw fixation: a case report. J Orthop Case Rep. April–June 2014;4(2):42-46.
2012	Ghate SD, Sistla VM, Nemade V, Vibhute D, Shahane SM, Samant AD. Screw and wire fixation for Lisfranc fracture dislocations. J Orthop Surg. 2012;20(2):170-175.
2012	Zhang H, Min L, Wang G-L, Huang Q, Liu K, Liu L, Tu C, Pei F-X. Primary open reduction and internal fixation with headless compression screws in the treatment of Chinese patients with acute Lisfranc joint injuries. J Trauma Acute Care Surg. May 2012;72(5):1380-1385.
2016	Mangin M, Seivert V, Galliot F, Lefevre M, Piessat C, Gross J-B, Delagoutte J-P, Coudane H. Résultats des arthrorises entre le deuxième métatarsien et le cunéiforme médial dans les luxations tarsométatarsiennes: à propos de 15 cas à un recul de cinq ans [Outcome after arthrorisis of the second metatarsal’s base with the medial cuneiform after tarsometatarsal dislocations: about 15 patients in 5 years]. Méd Chir Pied. June 2016;32(2):54-60.
2014	Haytmanek CT Jr, Clanton TO. Ligamentous Lisfranc injuries in the athlete. Operative Tech Sports Med. December 2014;22(4):313-320.
2019	Haraguchi N, Ota K, Ozeki T, Nishizaka S. Anatomical pathology of subtle Lisfranc injury. Sci Rep. October 16, 2019;9:14831.
2010	Nery C, Réssio C, Marion Alloza JF. Neoligamentplasty for the treatment of subtle ligament lesions of the intercuneiform and tarsometatarsal joints. Tech Foot Ankle Surg. 2010;9(3):92-99.
2012	Crates JM, Barber FA. Dual TightRope fixation for subtle Lisfranc injuries. Tech Foot Ankle Surg. December 2012;11(4):163-167.
2011	Aronow MS. Joint preserving techniques for Lisfranc injury. Tech Orthop. 2011;26(1):43-49.
2018	Aboueddahab Z. Les fractures luxations de Lisfranc: Etude retrospective d’une serie de 10 cas [Lisfranc Fracture-Dislocation: Retrospective Study of 10 Cases] Mohammed V University; 2018.