Outcomes Following Posterior and Posterolateral Plating of Distal Fibula Fractures

2018 ◽  
Vol 12 (3) ◽  
pp. 246-252 ◽  
Author(s):  
Danica D. Vance ◽  
Hasani W. Swindell ◽  
Justin K. Greisberg ◽  
James T. Vosseller
Keyword(s):  
Functional Outcomes ◽  
Demographic Data ◽  
Tendon Injury ◽  
Hardware Removal ◽  
Peroneal Tendon ◽  
Ankle Pain ◽  
Distal Fibula ◽  
Lateral Posterior ◽  
Fibular Fixation

Ankle fractures are common orthopaedic injuries often requiring open reduction and internal fixation. A variety of positions for plate placement exist for surgical fixation of distal fibula fractures, including direct lateral, posterior, or posterolateral. Direct lateral is more common, despite evidence that posterior and posterolateral placement is mechanically superior. However, concern for peroneal tendon injury from posterior plating remains. Our study investigates clinical and functional outcomes of patients who underwent operative fixation of distal fibula fractures with posterior or posterolateral plating over a 3-year period. Analyses were performed on 59 patients with at least 2 years of follow-up. Questionnaires were used to obtain demographic data, in addition to information regarding the presence of ankle pain, subsequent hardware removal, and Foot and Ankle Outcome Scores (FAOS). In patients with at least 2 years of follow-up (average 39.6 ± 10.6 months), 37.2% reported ongoing ankle pain; 11 patients underwent hardware removal (18.6%), with 8 patients undergoing removal because of hardware-related pain (13.6%). FAOS scores (n = 51) were as follows: pain (79.9 ± 22.3), activities of daily living (84.2 ± 22.6), symptoms (75.7 ± 23.5), sports (69.4 ± 31.6), and quality of life (58.3 ± 30.5). Posterior and posterolateral plating achieved good clinical and high functional outcomes across our study population. The percentage of hardware removal in our study was either equivalent to, or less than, historical controls for any type of fibular fixation, and removal may be helpful for those patients whose postoperative ankle pain is subjectively related to the hardware. Levels of Evidence: Therapeutic, Level IV: Retrospective

scholarly journals Chronic Deltoid Ligament Insufficiency Repair with Internal Brace™ Augmentation

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Manuel Pellegrini ◽  
Giovanni Carcuro ◽  
Natalio Cuchacovic ◽  
Marcelo Somarriva ◽  
Mario Escudero Heldt ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Short Form ◽  
Stage Iv ◽  
Deltoid Ligament ◽  
Foot And Ankle ◽  
Ankle Pain ◽  
Ligament Repair ◽  
Sf 36 ◽  
Internal Brace

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Patients with chronic deltoid ligament insufficiency (CDLI) present a challenging situation in foot and ankle surgery. Although numerous surgical procedures have been described, optimal treatment is still a matter of debate. While the treatment armamentarium ranges from simple ligament repair to complex deltoid reconstructions with or without realignment osteotomies, direct repair augmented with an Internal Brace™ (Arthrex, Inc., Naples FL, USA) device appears to be an attractive intermediate option. We investigated functional outcomes and complications in patients with CDLI operated on using Internal Brace™ augmentation. Methods: After IRB approval, a prospective study was conducted. Patients were included if they were older than 18 years, presented medial ankle pain and/or giving way, exhibited asymmetric flexible hindfoot valgus, failed conservative treatment, and had a positive MRI evaluated by an independent radiologist. Patients with less than six months of follow-up, stage IV flatfoot deformity, neuropathy and/or inflammatory arthritis were excluded from the study. CDLI diagnosis was confirmed intraoperatively with the arthroscopic ankle drive-through sign. Patients were evaluated preoperatively and postoperatively using foot and ankle ability measure (FAAM) score, 36-item short form survey (SF-36), and grade of satisfaction. Paired t-tests were used to assess the pre- and postoperative FAAM and SF-36 scores. Results: Eleven patients met inclusion criteria. Nine patients were male and two female, with a mean age of 32 (18-61). Six ankles were right and five left. 88% presented with medial ankle pain, 67% medial drawer, 88% asymmetric hindfoot valgus, and 44% multidirectional ankle instability. No patient was lost to follow-up, with a mean follow-up time of 13.5 months (6-21). Preoperative FAAM and SF-36 scores improved from 58.7 to 75.3 and from 60.2 to 84.4 postoperatively, respectively (p<0.05). Two implant failures were observed, with no apparent compromise of construct stability. No patient was re-operated. Conclusion: Our results suggest that deltoid ligament repair with Internal Brace™ augmentation in patients with CDLI is a reliable option with good functional outcomes and high satisfaction grade in short term follow-up.

scholarly journals Does the Expensive IOFix implant Improve Union Rates?

2020 ◽  
Author(s):  
David Segal ◽  
Nissim Ohana ◽  
Meir Nyska ◽  
Ezequiel Palmanovich
Keyword(s):  
Demographic Data ◽  
Retrospective Chart Review ◽  
Fusion Rate ◽  
Hallux Rigidus ◽  
Hardware Removal ◽  
Functional Score ◽  
Fixation Devices ◽  
Operation Rate ◽  
The Mean

Abstract BACKGROUND First metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. METHODS We have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and X-ray radiographic studies. RESULTS Thirty patients were included in the study. The mean age was 60.36 ± 9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2 ± 12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5 ± 10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%. CONCLUSIONS This is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices.

scholarly journals Conservative Treatment Versus Repair Deltoid in SER Type IV Equivalent Ankle Fracture

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0000
Author(s):  
Chamnanni Rungprai
Keyword(s):  
Conservative Treatment ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
Deltoid Ligament ◽  
Medial Side ◽  
Type Iv ◽  
Sf 36 ◽  
Fibular Fixation ◽  
Return To Activity

Category: Trauma Introduction/Purpose: There remains a controversy to repair deltoid ligament in SER type IV equivalence of acute ankle fracture. Some surgeons prefer conservative treatment with casting while others prefer to repair deltoid ligament after distal fibular fixation. However, there is a little evidence to report comparative outcomes between the two methods. There remains a controversy to repair deltoid ligament in SER type IV equivalence of acute ankle fracture. Some surgeons prefer conservative treatment with casting while others prefer to repair deltoid ligament after distal fibular fixation. However, there is a little evidence to report comparative outcomes between the two methods. The purpose of this study was to report clinical and functional outcomes including complications between the two methods. Methods: A prospective, randomized collected data of 41 consecutive patients who were diagnosed with SER type IV equivalence acute ankle fracture and underwent either conservative treatment (20 patients) or deltoid repair (21 patients) between 2015 and 2017. A minimum follow up to be included in the study was 6 months (mean, 13.2 months; range, 6 to 30 months). The primary outcome was visual analogue scale (VAS), Short Form-36 (SF-36); physical and mental component scores, and FAAM; ADL and Sport. Pre- and post-operative SF-36, FAAM, and pain (Visual Analog Scale) were obtained and compared between the two groups using independent t-test. The secondary outcomes were time to return to activity of daily living, sports, work, and complications. Results: There were 41 patients (30 male and 11 female) with mean age of 29.7 years (range, 18-70 years) and mean BMI of 26.7 kg/m2 (range, 18.3-33.6 kg/m2). Both methods demonstrated significant improvement of post-operative functional outcomes (FAAM, SF-36, and VAS (p < 0.05 all)) compared to pre-operative period; however, there was no significant different between the two groups. Functional outcomes between casting and deltoid repair groups were time to return to activity of daily living (10.4 vs 11.7 weeks), works (12.1 vs 12.9 weeks), sport (25.9 vs 23.7 weeks), weight bearing medial clear space (2.9 vs 3.9 mm), and complications included medial side ankle pain (57 vs 15%) and painful scar (0 vs 15%) for cast and deltoid repair respectively. Conclusion: Both casting and deltoid repair were demonstrated significant improvement in terms of functional outcomes as measured with the FAAM, SF-36, and VAS in patients with SER IV equivalent ankle fracture. Although there was no significant difference of functional outcome in short term of follow-up, deltoid repair group was better in term of medial side ankle pain and lesser medial clear space widening.

scholarly journals Functional Outcomes of Isolated Infrasyndesmotic Fibula Fractures

2020 ◽  
Vol 5 (1) ◽  
pp. 247301141989222
Author(s):  
Ashlee Dobbe ◽  
Lauren A. Beaupre ◽  
Khaled Ali Almansoori ◽  
Tak-Shing Fung ◽  
Angela V. Scharfenberger
Keyword(s):  
Functional Outcomes ◽  
Clinical Information ◽  
Severe Disabilities ◽  
Distal Fibula ◽  
Level Of Evidence ◽  
Female Patients ◽  
Work Related ◽  
Radiographic Measurements ◽  
Patient Reported

Background: Ankle fractures are among the most common injuries encountered by orthopedic surgeons, with an incidence ranging from 71 to 187 per 100 000 people. Few studies have reliably investigated injuries involving isolated fractures of the distal fibula below the level of the ankle syndesmosis. Therefore, this study details on the patient-reported outcomes of nonoperatively managed isolated infrasyndesmotic fibula (ISF) fractures with a minimum 3-year follow-up. Methods: A retrospective population-based cohort study was undertaken across all emergency departments serving a major urban population. Among 159 consecutive patients meeting inclusion criteria, 108 agreed to participate. Clinical information, functional outcomes, and radiographic measurements were collected from electronic medical records and 3 validated outcome measures: the American Academy of Orthopaedic Surgeons (AAOS) Foot & Ankle Scale (FAS), the AAOS Shoe-Comfort Scale (SCS), and a general questionnaire. Results: An incidence of 22 ISF fractures per 100 000 people/year was found with FAS (91.2 ± 12.9) and SCS scores (76.8 ± 27.7), similar to reported population norms. Approximately 40% of patients (n = 43) reported continuing symptoms including pain (81.8%), stiffness (68.1%), and/or instability (39.0%). Less than 13% (n = 14) reported “severe” disabilities, and no patients required operative intervention within the follow-up period. Less-favorable outcomes were reported among work-related injuries, female patients, and “avulsion-type” fractures less than 10 mm in height ( P < .01). No relationships were identified between age, degree of articular-incongruity, fracture-displacement, and self-reported outcomes. Conclusions: The majority of patients with nonoperatively managed ISF fractures reported good-to-excellent early functional outcomes. Less-favorable outcomes were reported among work-related injuries, female patients, and “avulsion-type” fractures. Level of Evidence: Level III, comparative series.

scholarly journals Does the IOFix implant Improve Union Rates?

2020 ◽  
Author(s):  
david segal ◽  
Nissim Ohana ◽  
Meir Nyska ◽  
Ezequiel Palmanovich
Keyword(s):  
Demographic Data ◽  
Retrospective Chart Review ◽  
Fusion Rate ◽  
Hallux Rigidus ◽  
Hardware Removal ◽  
Functional Score ◽  
Level Of Evidence ◽  
Operation Rate ◽  
The Mean

Abstract BACKGROUND First metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. METHODS We have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies. RESULTS Thirty patients were included in the study. The mean age was 60.36±9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2±12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5±10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%.CONCLUSIONS This is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices.LEVEL OF EVIDENCE: 4

scholarly journals Functional Outcomes after Fracture-Dislocation of the Ankles

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Direk Tantigate ◽  
J. Turner Vosseller ◽  
Justin Greisberg ◽  
Benjamin Ascherman ◽  
Joshua Kirschenbaum ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
Sport Activity ◽  
Hardware Removal ◽  
Ankle Fractures ◽  
Fracture Dislocation ◽  
Significant Difference ◽  
Fracture Dislocations

Category: Ankle, Trauma Introduction/Purpose: Fracture-dislocation of the ankle represents a substantial injury to the bony and soft tissue structures of the ankle. Although there is a wealth of reported outcome after operative treatment of ankle fractures, there has been a limited focus on functional outcome of surgically treated ankle fracture-dislocations. The purpose of this study is to compare short-term functional outcome after open reduction and internal fixation (ORIF) in ankle fractures with and without dislocation. Methods: A retrospective chart review of ankle fractures surgically treated by ORIF over a three year period was performed. All ankle fracture patients 18 years or older with a minimum of 12 months follow-up were included. Demographic data, type of injury (bimalleolar, trimalleolar, etc.), operative time, complications, and functional outcomes were recorded. Functional outcome was determined by Foot and Ankle Outcome Score (FAOS) at the latest follow up visit. Comparison of demographic variables and the subcategories of FAOS including symptoms, pain, activities of daily living (ADL), sport activity and quality of life (QOL) were performed in ankle fractures with dislocation and without dislocation. A total of 62 patients were eligible for analysis, 38 (61.3%) were female. Twenty patients (32.3%) were fracture-dislocations and 42 (67.7%) had no dislocation. Mean age of patients was 48.44 ± 17.89 years (range, 19-85 years). Mean follow-up time is 39.79 ± 13.53 months (range, 12-76 months). Results: The fracture-dislocation cohort demonstrated worse FAOS than the nondislocation cohort (symptoms 73 vs 79, pain 75 vs 85, ADL 80 vs 88, Sport 63 vs 76 and QOL 54 vs 60, respectively), although none of these differences were statistically significant. Patients with ankle fracture-dislocation had more bony injury (i.e. more bimalleolar and trimalleolar injuries) (P = .007) and had a higher rate of subsequent hardware removal (11.9% vs 35%, P = .031) There was no statistically significant difference in patient demographics or the rate of complications. Conclusion: Fracture-dislocations of the ankle presented with more bimalleolar and trimalleolar fractures, although there was no statistically significant difference in terms of functional outcome. Subsequent surgery for hardware removal was higher in the dislocation cohort. Although our data showed no difference in outcome, there was a trend towards worse outcomes in the dislocation cohort that a larger study may be able to discern.

scholarly journals Does the IOFix implant improve union rates?

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
David Segal ◽  
Nissim Ohana ◽  
Meir Nyska ◽  
Ezequiel Palmanovich
Keyword(s):  
Demographic Data ◽  
Retrospective Chart Review ◽  
Fusion Rate ◽  
Hallux Rigidus ◽  
Hardware Removal ◽  
Functional Score ◽  
Level Of Evidence ◽  
Operation Rate ◽  
The Mean

Abstract Background First metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. Methods We have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies. Results Thirty patients were included in the study. The mean age was 60.36 ± 9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2 ± 12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5 ± 10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%. Conclusions This is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices. Level of evidence 4

scholarly journals Microfracture of subchondral bone leads to persistent subchondral sclerosis and poorer functional outcomes following distraction arthroplasty of the ankle joint while biologic augment may improve recovery times

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005 ◽  
Author(s):  
Arianna Gianakos ◽  
John Kennedy
Keyword(s):  
Subchondral Bone ◽  
Functional Outcomes ◽  
Demographic Data ◽  
Treatment Strategies ◽  
Joint Space ◽  
Additional Treatment ◽  
Biologic Agent ◽  
Distraction Arthroplasty ◽  
Return To Activity

Category: Ankle Arthritis Introduction/Purpose: Treatment of ankle osteoarthritis (OA) continues to remain a challenge. Previous reports have demonstrated the short-term benefits of using joint distraction for the treatment of ankle (OA), however, its efficacy in long term clinical outcomes and its role in preserving the joint space remains controversial. The purpose of this study is to establish whether microfracture or biologics improve the outcomes of ankle distraction. Methods: Records of patients that underwent an ankle distraction procedure between January 2009-December 2013 were retrospectively reviewed. Four groups were identified: Group 1: distraction with no additional treatment, Group 2: distraction with microfracture, Group 3: distraction with microfracture and BMAC/PRP, Group 4: distraction with BMAC/PRP. Demographic data was recorded. Pre-and-postoperative range of motion, Foot and Ankle Outcome Scores (FAOS), complication rate, and return to activity were evaluated. Radiographic images were used to assess the joint space changes pre-operatively and post-operatively. Global comparisons were performed using chi square testing, while individual between-group comparisons were made using robust, resistant regression and Wald tests. Results: Eighty-one patients with a mean age of 47 (range, 37-69) underwent ankle distraction with a mean follow up of 5 years (range, 3-6). All treatment strategies resulted in statistically significant improvements in FAOS (<0.001). Groups that underwent microfracture had a statistically significant decrease in post-operative plantarflexion, dorsiflexion, subtalar inversion and subtalar eversion (p=0.003) as well as an overall decrease in joint space (0.002) with persistence of subchondral bone sclerosis. Patients who underwent distraction with no microfracture treatment resulted in a significant increase in post-operative joint space (p=0.001) and decreased sclerosis in the subchondral bone. Average return to activity was 6 months in patients who received BMAC/PRP with ankle distraction compared to 12 months in patients who were treated with ankle distraction and microfracture (p<0.01). Conclusion: Distraction arthroplasty results in good functional outcomes at medium term follow up. The addition of microfracture seems to create functional outcome deterioration, whereas the addition of a biologic agent either BMAC or PRP appears to benefit earlier return to function. Longer-term studies will be required to see if these effects are sustained.

scholarly journals Does the IOFix implant Improve Union Rates?

2020 ◽  
Author(s):  
david segal ◽  
Nissim Ohana ◽  
Meir Nyska ◽  
Ezequiel Palmanovich
Keyword(s):  
Demographic Data ◽  
Retrospective Chart Review ◽  
Fusion Rate ◽  
Hallux Rigidus ◽  
Hardware Removal ◽  
Functional Score ◽  
Fixation Devices ◽  
Operation Rate ◽  
The Mean

Abstract BACKGROUNDFirst metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. METHODSWe have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies. RESULTS Thirty patients were included in the study. The mean age was 60.36±9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2±12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5±10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%.CONCLUSIONSThis is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices.

scholarly journals Short-Term Results of Lisfranc Injuries Treated with the Suture Button Technique

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0037
Author(s):  
Guilherme H. Saito ◽  
Alberto A. M. Mendes ◽  
Danilo R. C. Nishikawa ◽  
Beatriz Devito ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Articular Surface ◽  
Insertion Site ◽  
Hardware Removal ◽  
Short Term ◽  
Suture Button ◽  
Loss Of Reduction ◽  
The Mean ◽  
Lisfranc Injuries

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: Primary fixation with screws or plates or primary arthrodesis are considered the gold-standard surgical treatment options for Lisfranc injuries. However, drawbacks of these procedures include loss of joint motion, need for later hardware removal, injury of the articular surface by screws and nonunion. Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws and minimize the harm to the joint cartilage. The aim of the present study was to provide the short-term results of Lisfranc injuries treated with the suture button technique. Methods: Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated with the use of the Mini Tight Rope (Arthrex, Naples, FL) between April 2014 and November 2017. Medical records and radiographic images were retrospectively analyzed by independent observers with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 (range, 6-49) months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up. Results: At a mean follow-up of 32 months, the average AOFAS score was 95.8 (range, 82-100) and the mean VAS was 0.6 (range, 0-2). All patients but one were able to return to their previous activities. Twelve patients were very satisfied with the outcomes and four were satisfied or partially satisfied. A total of 9 complications were observed in 6 patients, with discomfort on the button insertion site being the most common (4 cases). Other complications included evidence of radiographic arthritis (3 cases), loss of reduction (1 case) and extensor hallucis longus tendinopathy (1 case). Only 1 patient required a reoperation for removal of the suture button. Conclusion: The use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. This technique is potentially less harmful to the articular cartilage and generally does not require hardware removal. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.

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