Randomized, Prospective Comparison of Bioabsorbable and Steel Screw Fixation of Lisfranc Injuries

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Abstract

Objective: This study's objective is to compare outcomes of bioabsorbable versus steel screws for treating Lisfranc injuries. Design: This research was conducted in a prospective and randomized manner between September 2008 and December 2013. Setting: This study was performed in the outpatient setting at a tertiary-level care center in a single surgeon's practice. Patients/Participants: Forty patients with acute Lisfranc injuries, amenable to open reduction and screw fixation, enrolled and presented for final follow-up. Intervention: Through randomization, 20 and 20 patients received bioabsorbable versus steel screws, respectively. Outcome Measurements: Function and pain were graded using the Foot and Ankle Ability Measures (FAAM) and a visual analog scale of pain. Radiographs were assessed for joint stability and degeneration. Results: For those with steel screws, the mean FAAM score increased from 24.9 to 89.6 of 100 and pain score decreased from 6.5 to 1.9 of 10 by latest follow-up. For those with absorbable screws, the mean FAAM score increased from 32.5 to 91.2 and pain score decreased from 4.7 to 1.3 by latest follow-up. These differences in final mean function (P = 0.4) and pain (P = 0.25) between the study groups were not statistically significant. Final radiographs showed no Lisfranc instability in any study patients, but rather midfoot arthritis in 4 and 2 patients with steel versus bioabsorbable screws, respectively. None of the patients who received steel screws had hardware-related problems, but 1 patient who received absorbable fixation developed an inflammatory reaction at a nonresorbed screw head at 2 years after surgery. Conclusions: Bioabsorbable screws provide short-term results that are comparable and not significantly different from steel screws for treating unstable Lisfranc injuries. Both methods are predictable in improving function and pain, but using absorbable screws eliminates the need for hardware removal after such trauma. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.