Lisfranc open reduction and internal fixation in an athletic population: screw versus suture button fixation

Background: Primarily ligamentous Lisfranc injuries occur in athletic populations. Unstable Lisfranc injuries are treated with internal fixation or arthrodesis. Internal fixation has been described with both screws and suture button devices, but there currently are only case reports in the medical literature describing the use of suture buttons. This study assessed the return to duty rate, time to full activity, hardware removal rate, and complications after open reduction and internal fixation (ORIF) of primarily ligamentous Lisfranc injuries in an active duty military population, comparing screw fixation with suture button fixation. Methods: A retrospective review was performed of ORIF of Lisfranc injuries performed at our institution from 2009-2012. Inclusion criteria were active duty at the time of surgery, primarily ligamentous Lisfranc injuries undergoing ORIF, and minimum 6-month follow-up. Twelve patients were identified who met the inclusion criteria. Results: Six patients underwent screw fixation (five men and one woman with a mean age of 25.7 yr). Six underwent suture button fixation (five men and one woman, with a mean age of 29.7 yr). Only half of the patients in the screw fixation group returned to full activity, whereas all patients in the suture button fixation group returned to full activity. Average time to return to full activity was 358 days in the screw fixation group and 181 days in the suture button group. The hardware removal rate was 83% in the screw fixation group, with no hardware removals in the suture button group. Conclusions: Our results demonstrate that suture button fixation serves as a viable alternative to screw fixation in an athletic population.