Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas.
Foot Ankle Spec. 2021 Aug;14(4):312-316. doi: 10.1177/1938640020913447. Epub 2020 Apr 17.
Injury to the Lisfranc interosseous ligament is currently managed with a screw. However, this can potentially further disrupt the ligament. The objective of this study was to observe the proximity of the screw or disruption it can cause at the ligament attachment sites. Twenty-three feet were studied. A 40-mm, 4.0, partially threaded, cannulated screw was inserted from the base of the second metatarsal into the medial cuneiform. The relationship of the ligament attachment sites to the screw hole were measured. The screw hole contacted at least 1 of the ligament attachment sites in 20 of the 23 feet. The screw hole fully penetrated it in 7 feet, partially disrupted it in 4 feet, and had less than or equal to 1 mm of contact in 9 feet. There was no contact with either of the attachment sites in 3 feet, with an average distance of 1.5 mm separating them. Conclusion. Our results show the proximity of the ligament to the screw and the disruption that can result from its insertion. This is clinically relevant as some amount ligamentous disruption is likely to occur with insertion of the "Lisfranc screw," which may interfere with its healing process. Level V: Expert opinion includes case reports and technique tips.
足跖跗间的 Lisfranc 韧带损伤目前采用螺钉固定。然而，这可能会进一步破坏韧带。本研究的目的是观察螺钉的位置以及它在韧带附着处可能造成的破坏。研究了 23 只脚。从第二跖骨底部向内侧楔骨插入一根 40mm、4.0、部分螺纹、套管螺钉。测量了韧带附着点与螺钉孔的关系。在 23 只脚中的 20 只脚上，螺钉孔至少接触到 1 个韧带附着点。在 7 只脚上，螺钉孔完全穿透了它，在 4 只脚上部分破坏了它，在 9 只脚上只有小于或等于 1mm 的接触。在 3 只脚上没有与任何一个附着点接触，它们之间的平均距离为 1.5mm。结论。我们的结果显示了韧带与螺钉的接近程度以及插入螺钉可能导致的破坏。这在临床上很重要，因为插入“跖跗骨螺钉”时可能会导致一定程度的韧带撕裂，这可能会干扰其愈合过程。等级五：专家意见包括病例报告和技术提示。
