Comparison of Standard Screw Fixation Versus Suture Button Fixation in Lisfranc Ligament Injuries

Background: The standard operative treatment for Lisfranc injuries is to openly reduce them and use screw fixation. Due to the current trend of applying a more physiologic fixation and decreasing the need for screw removal, a recent interest has developed in suture-button fixation. The purpose of this study was to compare the suture button technique for Lisfranc fracture fixation to the traditional interfragmentary screw fixation. Materials and Methods: Eight fresh-frozen matched paired cadavers with an average age of 50 (range, 37 to 55) years were tested. For each specimen, the distance between marked points on the base of the first metatarsal and second metatarsal was measured. The distance was then remeasured when a 600 Newton load was applied to the specimen with an intact ligament, a sectioned Lisfranc ligament, and after the fixation method. Results: Fixed loaded measurement displacements were significantly (p < 0.00) smaller with screw fixation compared to their respective intact loaded measurements. Fixed loaded measurement displacements were significantly (p = 0.001) smaller than the fixed unloaded measurements in the screw group when compared to the suture button group. Conclusion: In the current cadaveric model, standard interfragmentary screw fixation with a 4.0 cannulated screw had less displacement than the Arthrex Mini Tightrope in isolated Lisfranc ligament injuries. Therefore, we conclude that until more comparative studies are performed with more accurate measuring devices, open reduction and screw fixation of these injuries should continue to be the accepted treatment.