Abstract
There currently exists an array of operative strategies to manage Lisfranc injuries. Modular fixation systems present surgeons with a choice between fully threaded solid cortical (FSC) and partially threaded cannulated cancellous (PCC) bone screws when using a transarticular screw approach. It is currently unknown how screw design influences fixation strength in Lisfranc reconstructions. The purpose of this study was to evaluate the biomechanical differences of FSC and PCC screws using a cadaveric model of a simulated Lisfranc injury and controlled benchtop experiments. Ten matched pairs of cadaveric feet received an acute Lisfranc injury and were repaired with FSC or PCC screws. Diastasis was measured between the medial and intermediate cuneiforms and the first and second metatarsals during simulations of partial weight bearing. Three-point bending and axial pull-out tests were performed to characterize screw mechanics that could not be measured within the cadaveric model. Screw design did not affect cuneiform or metatarsal diastasis. Neither screw loosening nor deformation was observed following cadaveric testing. Bending tests indicated FSC screws had higher ultimate strength, but there was no significant difference in yield load. Partially threaded cannulated cancellous bone screws exhibited superior axial pull-out strength. Fully threaded solid cortical and PCC screws provide equal amounts of fixation strength during partial weight bearing and similar resistance to deformation under bending loads. Partially threaded cannulated cancellous screws may simplify the operative procedure and minimize nonoptimal screw placement. If a clinician so desires, PCC screws may be used in lieu of FSC screws without sacrificing fixation strength. [Orthopedics. 2018; 41(2):e222–e227.]
- 1.Eleftheriou KI, Rosenfeld PF, Calder JD. Lis-franc injuries: an update. Knee Surg Sports Traumatol Arthrosc. 2013; 21(6):1434–1446.
10.1007/s00167-013-2491-2 Crossref Medline, Google Scholar - 2.Stavlas P, Roberts CS, Xypnitos FN, Giannoudis PV. The role of reduction and internal fixation of Lisfranc fracture-dislocations: a systematic review of the literature. Int Orthop. 2010; 34(8):1083–1091.
10.1007/s00264-010-1101-x Crossref Medline, Google Scholar - 3.Aitken AP, Poulson D. Dislocations of the tarsometatarsal joint. J Bone Joint Surg Am. 1963; 45(2):246–383.
10.2106/00004623-196345020-00003 Crossref Medline, Google Scholar - 4.Arntz CT, Veith RG, Hansen ST. Fractures and fracture-dislocations of the tarsometatarsal joint. J Bone Joint Surg Am. 1988; 70(2):173–181.
10.2106/00004623-198870020-00003 Crossref Medline, Google Scholar - 5.Englanoff G, Anglin D, Hutson HR. Lisfranc fracture-dislocation: a frequently missed diagnosis in the emergency department. Ann Emerg Med. 1995; 26(2):229–233.
10.1016/S0196-0644(95)70156-7 Crossref Medline, Google Scholar - 6.Lattermann C, Goldstein JL, Wukich DK, Lee S, Bach BR. Practical management of Lisfranc injuries in athletes. Clin J Sport Med. 2007; 17(4):311–315.
10.1097/JSM.0b013e31811ed0ba Crossref Medline, Google Scholar - 7.Bloome DM, Clanton TO. Treatment of Lisfranc injuries in the athlete. Tech Foot Ankle Surg. 2002; 1(2):94–101.
10.1097/00132587-200212000-00003 Crossref, Google Scholar - 8.Buzzard BM, Briggs PJ. Surgical management of acute tarsometatarsal fracture dislocation in the adult. Clin Orthop Relat Res. 1998; 353:125–133.
10.1097/00003086-199808000-00014 Crossref, Google Scholar - 9.Kuo RS, Tejwani NC, Digiovanni CW, Outcome after open reduction and internal fixation of Lisfranc joint injuries. J Bone Joint Surg Am. 2000; 82(11):1609–1618.
10.2106/00004623-200011000-00015 Crossref Medline, Google Scholar - 10.Marsland D, Belkoff SM, Solan MC. Biomechanical analysis of endobutton versus screw fixation after Lisfranc ligament complex sectioning. Foot Ankle Surg. 2013; 19(4):267–272.
10.1016/j.fas.2013.06.009 Crossref Medline, Google Scholar - 11.Myerson MS, Fisher RT, Burgess AR, Kenzora JE. Fracture dislocations of the tarsometatarsal joints: end results correlated with pathology and treatment. Foot Ankle. 1986; 6(5):225–242.
10.1177/107110078600600504 Crossref Medline, Google Scholar - 12.Richter M, Wippermann B, Krettek C, Schratt HE, Hufner T, Thermann H. Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results. Foot Ankle Int. 2001; 22(5):392–398.
10.1177/107110070102200506 Crossref Medline, Google Scholar - 13.Alberta FG, Aronow MS, Barrero M, Diaz-Doran V, Sullivan RJ, Adams DJ. Ligamentous Lisfranc joint injuries: a biomechanical comparison of dorsal plate and transarticular screw fixation. Foot Ankle Int. 2005; 26(6):462–473.
10.1177/107110070502600607 Crossref Medline, Google Scholar - 14.Desmond EA, Chou LB. Current concepts review: Lisfranc injuries. Foot Ankle Int. 2006; 27(8):653–660.
10.1177/107110070602700819 Crossref Medline, Google Scholar - 15.Dundon JM, Gould GC, Herbineck MA, Hamilton JA. Cannulated screw with solid core insert: stronger than cannulated screws. Am J Orthop (Belle Mead NJ). 2014; 43(9):E191–E193. Medline, Google Scholar
- 16.Wang T, Boone C, Behn AW, Ledesma JB, Bishop JA. Cancellous screws are biomechanically superior to cortical screws in metaphyseal bone. Orthopedics. 2016; 39(5):e828–e832.
10.3928/01477447-20160509-01 Link, Google Scholar - 17.Patel PS, Shepherd DE, Hukins DW. The effect of screw insertion angle and thread type on the pullout strength of bone screws in normal and osteoporotic cancellous bone models. Med Eng Phys. 2010; 32(8):822–828.
10.1016/j.medengphy.2010.05.005 Crossref Medline, Google Scholar - 18.Panchbhavi VK, Vallurupalli S, Yang J, Andersen CR. Screw fixation compared with suture-button fixation of isolated Lisfranc ligament injuries. J Bone Joint Surg Am. 2009; 91(5):1143–1148.
10.2106/JBJS.H.00162 Crossref Medline, Google Scholar - 19.ASTM International. ASTM F543-13e1: Standard specification and test methods for metallic medical bone screws. ASTM International. https://www.astm.org/DATABASE.CART/HISTORICAL/F543-13E1.htm. Google Scholar
- 20.Burkhart KJ, Nowak TE, Appelmann P, Sternstein W, Rommens PM, Mueller LP. Screw fixation of radial head fractures: compression screw versus lag screw. A biomechanical comparison. Injury. 2010; 41(10):1015–1019.
10.1016/j.injury.2010.03.001 Crossref Medline, Google Scholar
