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

Vinod Panchbhavi, Santaram Vallurupalli, Jinping Yang, Clark R. Andersen

Research output: Contribution to journalArticle

66 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1143-1148
Number of pages6
JournalJournal of Bone and Joint Surgery - Series A
Volume91
Issue number5
DOIs
StatePublished - May 1 2009

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Ligaments
Sutures
Wounds and Injuries
Metatarsal Bones
Joints
Weight-Bearing
Cadaver
Foot
Bone and Bones

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Screw fixation compared with suture-button fixation of isolated lisfranc ligament injuries. / Panchbhavi, Vinod; Vallurupalli, Santaram; Yang, Jinping; Andersen, Clark R.

In: Journal of Bone and Joint Surgery - Series A, Vol. 91, No. 5, 01.05.2009, p. 1143-1148.

Research output: Contribution to journalArticle

Panchbhavi, Vinod ; Vallurupalli, Santaram ; Yang, Jinping ; Andersen, Clark R. / Screw fixation compared with suture-button fixation of isolated lisfranc ligament injuries. In: Journal of Bone and Joint Surgery - Series A. 2009 ; Vol. 91, No. 5. pp. 1143-1148.
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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.",
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