A Comparison of Steel and Bioabsorbable Screw Fixation of Lisfranc Foot Injuries
I hypothesize that absorbable screw fixation of the foot's Lisfranc ligaments does not yield significant differences in postoperative foot stability, ligament function, and symptoms when compared to steel screw fixation. In addition, absorbable screw fixation of the Lisfranc ligaments offers the advantage that a second surgical procedure to remove the screw is not necessary.
The Lisfranc ligaments are a group of ligaments that connect the bones of the middle portion of the foot to each other. The Lisfranc ligaments allow for a normal and stable range of motion and shape to the foot.
When the Lisfranc ligaments are disrupted, the stability it had given to the middle of the foot is lost. Attempted activity at the foot will result in pain and abnormal motion. If injury to the Lisfranc ligaments is left untreated, the eventual end result is foot arthritis and deformity.
The current standard orthopaedic treatment of Lisfranc ligament injuries is surgery. The Lisfranc ligaments are fixed by compressing the space between the middle bones of the foot with steel screws. These screws allow for ligament healing. As the ligaments heal, the patient should not resume activity with the fixed foot too soon as the screw may break. A second surgical procedure is often recommended to remove the screw 6 months after surgery. This allows for a complete return of normal foot range of motion, but at the cost of a second procedure.
The use of materials that can be absorbed by the human body to fix the Lisfranc ligaments has only been studied in 1 paper. One such material is the Smart Screw (Bionx, Blue Bell, Pennsylvania) which is approved by the Food and Drug Administration (F.D.A.) and made of polylevolactic acid (PLA). Absorbable screws could be ideal for the treatment of Lisfranc ligament injuries.
Comparing the long-term results of fixing the Lisfranc ligaments with either a steel or absorbable screw is important as there are no studies on the subject to date. There is only 1 published study regarding absorbable screws to fix the Lisfranc ligaments. The purpose of this study is to compare the outcome of steel and absorbable screw fixation of the Lisfranc ligaments in foot injuries in one surgeon's (J.A.) practice at Thomas Jefferson University Hospital, Riddle Memorial Hospital, and Nazareth Hospital.
This study will be conducted in a prospective manner. This study does not focus on experimental procedures or components, but rather involves the accepted management of a select population of patients.
This study will be performed in a randomized, prospective manner involving 2 groups of patients (steel vs. bioabsorbable screw populations) from 3 different hospitals. Power analysis has been conducted to ensure an adequate patient population size.
The risks to patients will be minimal. The standard risks of fixing the Lisfranc ligaments include bleeding, infection, nerve injury, recurrent foot instability, and the dangers of administering anesthesia.
Study Groups Chosen patients for this study will be randomly assigned to one of two groups. Group A will consist of patients that receive the steel screw. Group B will contain the patients that receive the absorbable screw. Postoperative activity restrictions and rehabilitation will be kept the same between the two groups.
Routine protocols for care of foot fracture patients will be utilized regarding infection, wound care, pain control, and weightbearing restrictions. The involved foot will be placed in a non-weight-bearing splint that patients are requested to avoid handling until it is removed by the PI upon the first postoperative visit.
Patients who have their injury fixed using steel screws, need a second surgery in 6 months for removal of the screw. This is the standard textbook treatment and is not a revision surgery. Patients who will receive absorbable screw, wont need this surgery. This will be discussed with the patient at the time of the approach for recruitment.
Outcome evaluation The PI will monitor and follow the patients during and after surgery. Data collection will include the details of the surgery, intraoperative and postoperative course including complications if applicable, and number of revision surgeries performed should they occur. These patients received postoperative follow-up at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 3 years. Both groups of patients are prohibited from bearing weight on the affected foot for six weeks. Patients will be instructed to gradually increase weight-bearing starting at six weeks.
Postoperative satisfaction and function which will be scored according to the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot scale which is highly accepted for its validity, reliability, and reproducibility.
Patients will also be asked about their satisfaction with the surgical results using both the 10 cm visual analog scale (VAS) and a four-point scale (poor, mild, good, and excellent). Observed complications including need for further revision surgeries would be documented. All of this information would have been gathered during the patients' follow-up visits in the outpatient clinics after surgery. For those patients that receive a steel screw, they will receive a second outpatient surgical procedure after the 6-month postoperative follow-up to remove that screw using current standard orthopaedic technique.
Postoperative foot X-rays of these patients during their follow up in the outpatient setting will also be examined to view proper alignment and compression of the middle portion of the foot together which indicates healing of the Lisfranc ligaments. Radiographs are used to evaluate the screw for breakage. In the case of the absorbable screw, radiographs are also done to assess absorption.
Allocation: Randomized, Control: Active Control, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Linvatec 4.5 mm Smart Screw, Synthes 4.0 mm steel screw
Riddle Memorial Hospital
Rothman Institute Orthopaedics
Results (where available)
- Source: http://clinicaltrials.gov/show/NCT00689962
- Information obtained from ClinicalTrials.gov on July 15, 2010
Medical and Biotech [MESH] Definitions
Screw Worm Infection
Infection with larvae of the blow fly Cochliomyia hominivorax (Callitroga americanum), a common cause of disease in livestock in the southern and southwestern U.S.A.
Lack of stability of a joint or joint prosthesis. Factors involved are intra-articular disease and integrity of extra-articular structures such as joint capsule, ligaments, and muscles.
Stainless steel. A steel containing Ni, Cr, or both. It does not tarnish on exposure and is used in corrosive environments. (Grant & Hack's Chemical Dictionary, 5th ed)
Chronic progressive degeneration of the stress-bearing portion of a joint, with bizarre hypertrophic changes at the periphery. It is probably a complication of a variety of neurologic disorders, particularly TABES DORSALIS, involving loss of sensation, which leads to relaxation of supporting structures and chronic instability of the joint. (Dorland, 27th ed)
Genetic disorder of mucopolysaccharide metabolism characterized by skeletal abnormalities, joint instability, development of cervical myelopathy, and excessive urinary keratan sulfate. There are two biochemically distinct forms, each due to a deficiency of a different enzyme.
The Lisfranc ligaments are a group of ligaments that connect the bones of the middle portion of the foot to each other. The Lisfranc ligaments allow for a normal and stable range of motio...
The primary purpose of this study is to assess the impact of sliding hip screws versus cannulated screw fixation on rates of revision surgery at 2 years in individuals over 50 years of age...
The aim of the study is to determine the relative effectiveness of the PediGuardTM , a device manufactured by SpineVision, Inc, for placement of a pedicle screw pilot (drill) hole and for...
There has been a growing trend amongst surgeons to use a construct for correction of scoliosis which involves segmental instrumentation with pedicle screws. Pedicle screw proponents cit...
Evaluation of dynamic Plate-Screw-Systems for internal fixation after femoral neck fractures. Open Registry for Comparison of 1-screw-systems (DHS) with multi-screw-system Targon FN.
ABSTRACT: Purpose: The purpose of this study was to compare the interfragmentary compression force across a simulated scaphoid fracture by two commonly used compression screw systems; the Acutrak 2 St...
There are three basic concepts that are important to the biomechanics of pedicle screw-based instrumentation. First, the outer diameter of the screw determines pullout strength, while the inner diamet...
Biomechanical effects of the extent of sacrectomy on the stability of lumbo-iliac reconstruction using iliac screw techniques: What level of sacrectomy requires the bilateral dual iliac screw technique?
BACKGROUND: Although both single and dual iliac screw techniques are used in spino-pelvic reconstruction following sacrectomy for treating sacral tumors, the basis for choosing between the two techniq...
BACKGROUND: Internal fixation with dynamic hip screw is a choice of treatment for hip fractures to stabilize a femoral fracture. Choosing the proper implant and its material has a great effect on the...
To compare the biomechanical characteristics of screw versus plate versus both screw and plate fixation for large, type 3 O'Driscoll coronoid fractures.