Background:

The preferred method of fixation and surgical treatment for ligamentous Lisfranc injuries is controversial. Transarticular screws, bridge plating, fusion, and flexible fixation have been described, yet none have demonstrated superiority. Furthermore, screw fixation and plating often require secondary surgery to remove implants, leading surgeons to seek alternative fixation methods.

Purpose:

To compare transarticular screws and a fiber tape construct under a spectrum of biomechanical loads by evaluating the diastasis at 3 joints in the Lisfranc complex.

Study Design:

Controlled laboratory study.

Methods:

Eight matched pairs of fresh, previously frozen lower extremity cadaveric specimens were fixed with either 2 cannulated transarticular crossed screws or a fiber tape construct with a supplemental intercuneiform limb. The diastasis between bones was measured at 3 midfoot joints in the Lisfranc complex: the Lisfranc articulation, the second tarsometatarsal joint, and the intercuneiform joint. Measurements were obtained for the preinjured, injured, and fixation conditions under static loading at 50% donor body weight. Specimens then underwent cyclic loading performed at 1 Hz and 100 cycles, based on 100-N stepwise increases in ground-reaction force from 100 to 2000 N, to simulate postoperative loading from the partial weightbearing stage to high-energy activities. Failure of fixation was defined as diastasis ≥2 mm at the Lisfranc articulation (second metatarsal–medial cuneiform joint).

Results:

There were no significant differences in diastasis detected at the Lisfranc articulation or the intercuneiform joint throughout all loading cycles between groups. All specimens endured loading up to 50% body weight + 1400 N. Up to and including this stage, there were 2 failures in the cannulated transarticular crossed-screw group and none in the fiber tape group.

Conclusion:

The fiber tape construct with a supplemental intercuneiform limb, which does not require later removal, may provide comparable biomechanical stability to cannulated transarticular crossed screws, even at higher loads.

Clinical Relevance:

Ligamentous Lisfranc injuries are common among athletes. Therefore, biomechanical evaluations are necessary to determine stable constructs that can limit the time to return to play. This study compares the biomechanical stability of 2 methods of fixation for ligamentous injury through a wide spectrum of loading, including those experienced by athletes.

中文翻译：

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在尸体模型中纤维带装置与经关节螺钉治疗 Lisfranc 韧带损伤的生物力学比较

背景：

韧带 Lisfranc 损伤的固定和手术治疗的首选方法是有争议的。经关节螺钉、桥接板、融合和柔性固定已被描述，但没有一个显示出优越性。此外，螺钉固定和电镀通常需要二次手术来移除植入物，导致外科医生寻求替代固定方法。

目的：

通过评估 Lisfranc 复合体中 3 个关节的分离，比较在一系列生物力学载荷下的经关节螺钉和纤维带结构。

学习规划：

受控实验室研究。

方法：

八对匹配的新鲜、先前冷冻的下肢尸体标本用 2 个空心经关节交叉螺钉或带有补充楔骨间肢体的纤维带结构固定。在 Lisfranc 复合体的 3 个中足关节处测量骨骼之间的分离：Lisfranc 关节、第二跗跖关节和楔骨间关节。在 50% 供体体重的静态负载下，获得了受伤前、受伤和固定条件下的测量值。然后，样本在 1 Hz 和 100 个循环下进行循环加载，基于 100-N 逐步增加地面反作用力从 100 到 2000 N，以模拟从部分负重阶段到高能量活动的术后负荷。

结果：

在组间的所有加载循环中，Lisfranc 关节或楔骨间关节处检测到的分离没有显着差异。所有标本都承受了高达 50% 体重 + 1400 N 的载荷。直到并包括这一阶段，空心经关节十字螺钉组有 2 例失败，而纤维胶带组则没有。

结论：

具有补充楔骨间肢的纤维带结构不需要以后移除，即使在更高的负荷下，也可以提供与空心经关节交叉螺钉相当的生物力学稳定性。

临床相关性：

韧带 Lisfranc 损伤在运动员中很常见。因此，生物力学评估对于确定可以限制重返赛场时间的稳定结构是必要的。本研究比较了 2 种韧带损伤固定方法在各种负荷下的生物力学稳定性，包括运动员所经历的负荷。