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Category: Trauma Introduction/Purpose: Disagreement exists as to the optimal treatment of Lisfranc injuries of the midfoot. Some authors suggest that primary arthrodesis should be the treatment of choice, whereas others are proponents of open reduction and internal fixation (ORIF). There has been increased interest in using a suture button device in lieu of traditional screw fixation, which in general must be removed. Biomechanical studies comparing screw fixation with suture button devices have had conflicting results. The aim of this study was evaluate patients with Lisfranc injuries treated with a suture button radiographically over time. Methods: 43 patients with a Lisfranc injury treated surgically with a suture button device (Tightrope, Arthrex, Naples, FL) by two fellowship-trained orthopaedic foot and ankle surgeons were identified via a database query for the CPT code 28615 (open treatment of tarsometatarsal joint dislocation). The distances between the first and second metatarsal (M1-M2) and between the medial cuneiform and the second metatarsal (C1-M2) were measured on anterior-posterior (AP) radiographs using standardized, readily-identifiable landmarks. All measurements were performed independently by two musculoskeletal radiologists and were averaged. Accuracy of reduction was assessed by comparing measurements on weightbearing AP radiographs of the uninjured foot with the operatively-treated foot at 6 weeks postoperatively, also weightbearing. Maintenance of reduction over time was assessed by comparing measurements at 6 weeks postoperatively with measurements taken at the time of last follow-up. Measurements were also compared between the injured foot preoperatively and at time of last follow-up. T-tests using SPSS software were performed for statistical analysis in comparing the means of the different measurements. Results: Average radiographic follow-up was 35.8 weeks (6.1-178.9). Accuracy of reduction was less than 1 mm for both the M1- M2 and C1-M2 measurements when comparing the uninjured foot with the surgically-treated foot at 6 weeks postoperatively; this difference was significant in the C1-M2 measurement (difference = 0.77 mm, p=0.032), but not in the M1-M2 measurement (difference = 0.44 mm, p=0.190). There was no significant difference in measurements between 6 weeks postoperatively and at final follow-up (difference in M1-M2=0.22 mm, p=0.435; difference in C1-M2=0.27 mm, p=0.352). There was significant improvement in the measured distances of the injured foot preoperatively to that measured at final follow-up in the C1-M2 measurements (difference in C1-M2=-0.82mm, p=0.021), while the difference in the M1-M2 measurements approached significance (difference in M1-M2= -0.56 mm, p=0.067). Conclusion: To our knowledge, this is the first and largest series assessing radiographic outcomes of Lisfranc injuries in patients treated surgically with a suture button device. After open reduction of Lisfranc injuries, the suture-button device used in this study appears to adequately maintain...

Category: Midfoot/Forefoot Introduction/Purpose: Controversy exists regarding the optimal treatment of Lisfranc injuries of the midfoot. There has been increasing interest in using a suture button device in lieu of traditional screw fixation. Biomechanical studies comparing screw fixation with suture button devices have demonstrated conflicting results. This study evaluates the radiographic outcomes of patients with Lisfranc injuries treated with a suture button device or a hybrid technique with supplemental fixation. Methods: Forty-three patients with a Lisfranc injury were treated operatively with either a suture button device (Tightrope, Arthrex, Naples, FL) or a hybrid technique with supplemental hardware fixation. The distances between the first and second metatarsal (M1-M2) and the medial cuneiform and second metatarsal (C1-M2) were measured on weightbearing radiographs. These measurements were used to assess the accuracy of reduction, maintenance of reduction, and magnitude of reduction. The accuracy of reduction was determined by comparing weightbearing AP radiographs of the uninjured foot with weightbearing radiographs of the operatively treated foot at 6 weeks postoperatively. The magnitude of reduction was assessed via a comparison of weightbearing AP radiographs of the injured foot preoperatively to the operatively treated foot at 6 weeks postoperatively. The maintenance of reduction was determined by comparing radiographic measurements at 6 weeks postoperatively to measurements taken at 12 weeks postoperatively. Results: An accurate reduction was obtained in both treatment groups with no significant difference in the M1-M2 and C1-M2 measurements at 6 weeks postoperatively compared to the uninjured foot. The magnitude of reduction was greater and statistically significant for the hybrid fixation group but was not maintained (Hybrid fixation M1-M2 magnitude of reduction: -1.39, p < .001; C1-M2 magnitude of reduction: -1.77, p < .001). The suture button treatment group attained a satisfactory reduction that was maintained with no statistically significant difference in the M1-M2 and C1-M2 distances at 6 weeks and 12 weeks postoperatively (Tightrope M1-M2 maintenance of reduction: 0.04, p=0.88; C1-M2 maintenance of reduction: 0.39, p=0.21). Conclusion: After open reduction of Lisfranc injuries, the suture button device appears to adequately maintain the reduction when patients have returned to full activity. Based on radiographic parameters, the suture button construct provides an effective alternative to traditional screw fixation for the treatment of Lisfranc injuries.

Failure of a first metatarsophalangeal joint arthroplasty can be a debilitating condition for the patient and a challenging condition for the treating surgeon. This technique article highlights 2 techniques: the use of a tricortical iliac crest bone block allograft and also distal tibia autograft for metatarsophalangeal joint arthrodesis and management of the bony defect. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.