Loss of reduction after screw fixation of Lisfranc joint injuries: Does screw type matter?

Abstract

To evaluate for associations with loss or reduction (LOR) after fixation of Lisfranc joint injuries (LFJI). The secondary purpose was to compare 4.0 mm partially-threaded cannulated (4.0 PTC) and 3.5 mm fully-threaded solid (3.5 FTS) screw fixation. A retrospective comparative study at 2 level-one trauma centers was performed to evaluate patients with screw-only fixation of LFJI. Patient, injury, and screw fixation variables were collected. Associations with LOR were evaluated. Fixation with 4.0 PTC versus 3.5 FTS screws was compared in terms of LOR, screw breakage, and symptomatic screw removal. There were 78 patients included. The median age was 37.5 years (IQR 26.7-51.0) and 59.0% (n = 46) were male. The median follow-up was 6.7 months (IQR 3.8-14.3). Patients that had a LOR, versus those that did not, had a similar proportion of cannulated screws (57.1% vs. 40.6%, p = 0.26), 3.5 mm diameter screws (57.1% vs. 64.1%), fully-threaded screws (64.3% vs. 67.2%, p = 0.75), and antegrade (vs. retrograde) LFJ screws (78.6% vs. 59.4%, p = 0.32). The groups did not differ in age, Body Mass Index, high-energy mechanisms, joints fixed, or weeks to full weight bearing (p > 0.05). Fixation with 4.0 PTC (n = 26) versus 3.5 FTS screws (n = 43), did not differ in LOR (19.2% vs. 14.0%, p = 0.53), screw breakage (3.8% vs. 18.6%, p = 0.09), or symptomatic screw removals (19.2% vs. 18.6%, p = 0.88). LOR was not associated with any of the variables analyzed. Fixation with 4.0 PTC versus 3.5 FTS screws had similar rates of LOR, screw breakage, and symptomatic implant removal. Diagnostic Level III.