The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Use of Bio-integrative Screws for Fixation of Lisfranc Instability - Results from a Cadaver Study

Document Type : RESEARCH PAPER

Authors
Vasundhara Mathur 1
David Osei-Hwedieh 1
Sayyed-Hadi Sayyed-Hosseinian 1
Lorena Bejarano-Pineda 1
Philip Kaiser 1
Fernando Raduan 1
John Y. Kwon 1
Soheil Ashkani-Esfahani 2
Gregory R. Waryasz 1
1 Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
2 1 Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA 2 FARIL-SORG Collaborative, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
10.22038/abjs.2023.73584.3410
Abstract
Background: Majority of Lisfranc fracture-dislocations require anatomic reduction and rigid internal fixation to prevent debilitating sequelae. Current methods include solid screws and flexible fixations which have been in use for many years. Biointegrative screw is a newer option that has not yet been thoroughly investigated for its effectiveness for Lisfranc injuries.
Methods: The ligaments of the Lisfranc complex were resected in eight lower-leg cadaveric specimens. This was done by eight foot and ankle surgeons individually. Distraction forces were applied from opposite sides at the joint to replicate weight bearing conditions. Three methods of fixation – flexible fixation, metal, and biointegrative screws- were evaluated. The diastasis and area at the level of the ligament were measured at four conditions (replicated injury and each type of fixation) in neutral and distraction conditions using fluoroscopy images. The Wilcoxon test and Kruskal Wallis test were used for comparison. P value <0.05 was considered statistically significant.
Results: The diastasis values for the transected ligament scenario were greater than those after all three fixation methods (without distraction) and for metal screw and biointegrative screws (with distraction) (p<0.001). The area at the level of the ligament showed higher values for transected ligament than the three fixatives (p<0.05).
Conclusion: Metal screws, flexible fixation and bio-integrative screws showed comparable effectiveness intra-op in the successful correction of Lisfranc injury.
Keywords
Biointegrative implants
biomaterials
midfoot injuries
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 1
January 2024
Pages 51-57

  • Receive Date 11 July 2023
  • Revise Date 21 October 2023
  • Accept Date 30 October 2023