Flexible Fixation Treatment Strategies for Low-energy Lisfranc Injuries

Abstract

Ligamentous Lisfranc injuries are characterized by disruption between the articulation of the medial cuneiform and base of the second metatarsal. Ligamentous injuries can be either subtle or obvious and can also occur with tarsometatarsal subluxations or dislocations. These injuries typically happen in athletic activity and are also seen lower-energy falls. Conventional use of transarticular screws to repair Lisfranc ligament injuries has provided good outcomes; however, the screws are also believed to decrease the natural physiological movement of the Lisfranc joint. As treatment options for ligamentous Lisfranc injuries move away from transarticular screws and toward bridge plating and motion-preserving fixation techniques, the goal of stable fixation is still important for optimizing long-term results. This article will focus on the technique of using a suture button device, and also introduce the technique of Lisfranc InternalBrace fixation. The internal brace technique allows for less bone loss from drilling, allows for collagen ingrowth, and can be used in conjunction with bridge plating techniques. Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.

InternalBrace has biomechanical properties comparable to suture button but less rigid than screw in ligamentous lisfranc model

“…The suture button device lies within this range, and the InternalBrace is slightly more stiff. Clinically, this flexibility is desirable, especially for athletes, 5 though the literature has yet to determine the appropriate amount of motion. 4 A variety of techniques have been described for use of the InternalBrace including flatfoot reconstruction, lateral ligament stabilization and medial collateral ligament augmentation.…”

“…This may be particularly undesirable in athlete. 5 Furthermore, screw related complications were found in 16.1% of patients and post traumatic arthritis reported in as high as 49.6% of patients. 6 The InternalBrace (Arthrex, Inc., Naples, FL, USA) is a flexible fixation technique that may decrease iatogenic cartilage damage that occurs during fixation.…”

“…6 The InternalBrace (Arthrex, Inc., Naples, FL, USA) is a flexible fixation technique that may decrease iatogenic cartilage damage that occurs during fixation. 5 The InternalBrace uses a 2 mm k-wire across the cartilaginous area of the Lisfranc joint. This is smaller than the drill required for a 3.5 mm cortical screw, 3.0 mm cannulated screw or mini TightRope (Arthrex, Inc., Naples, FL, USA).…”

“…Other benefits include the potential for physiologic motion and collagen ingrowth. 5 Although these benefits may be seen with other suture button techniques, the InternalBrace also avoids a button on the medial cuneiform. Theoretically this may prevent bony erosion and soft tissue irritation on the tibialis anterior tendon, potentially decreasing the need for hardware removal.…”

“…Given these benefits, the InternalBrace may be an appropriate option for Nunley Stage 2 and 3 injuries and may allow for weight bearing before complete healing and earlier return to sport. 5,7 In general, biomechanical and clinical studies regarding the InternalBrace are extremely limited and to our knowledge, there are no studies that fit the fixation strategy used at the Lisfranc joint. We aimed to determine if the mechanical properties of the InternalBrace support its continued clinical use for Lisfranc injuries.…”