Flexible Fixation for Ligamentous Lisfranc Injuries

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: Surgical outcomes of Lisfranc injuries depend on achieving an anatomical and stable reduction. Severity of injury defines the best treatment option and surgical techniques vary from internal fixation to arthrodesis. While effective, limitations of commonly used metal implants include iatrogenic articular cartilage damage, implant breakage and need for implant removal. Additionally, these surgical techniques do not preserve tarsometatarsal (TMT) joint motion. This report demonstrates a novel, easy and inexpensive surgical technique to stabilize TMT joint instability utilizing “flexible fixation” utilized in a case series of 8 patients. Methods: A dorsal approach over the second metatarsal is performed in a standard fashion, after careful dissection and direct visualization of the joint, the TMT joint is anatomically reduced and stabilized with k-wires avoiding damage of the cartilage. Two 2.7 or 3.5 screws with washers are placed from dorsal to plantar in the base of the metatarsal and in the respective tarsal bone to serve as posts. A non-absorbable #2 FiberWire (Arthrex, Naples, Florida) is looped 3 to 5 times in a Figure-of-8 fashion around the screws beneath the washers, tensioned, knotted and secured by tightening the screws. Repeat fluoroscopic stress views are performed to ensure stability of the TMT joint. Results: N/A Conclusion: For selected patients with Lisfranc injuries demonstrating no significant comminution or gross instability, flexible fixation using sutures is a promising technique due its potential benefits over trans-articular screws or bridge-plating techniques. This technique is inexpensive, avoids iatrogenic cartilage damage and subsequent removal of hardware.

Comparison of Suture-Augmented Ligamentplasty to Transarticular Screws in a Lisfranc Cadaveric Model

“…Recently, there have been investigations of modern treatment options that explore physiologic fixation methods of this joint. 2 The interest in mobile fixation methods arose from the proven concept in the ankle that it is reasonable to fix the syndesmosis with flexible fixation. 5,9 This is corroborated by a gait analysis study of patients who have had Lisfranc joint stabilization with transarticular screws or arthrodesis.…”