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.