Suture bridge and other suspensory fixation methods typically refer to constructs that consist of a very strong piece of...
Foot fracture/Ligament Repair
Evolution of Foot fracture/Ligament Repair
Treatment of these injuries varies based on how the Lisfranc ligament is disrupted: either a tear in the ligament itself or fractures in the bones around the ligament. Lisfranc injuries with fractures can usually be treated with fixation with plates and screws, while purely ligamentous injuries have typically been treated with fusion procedures in order to get the injury to heal. However, advances in suture bridge technology have led to the use of these constructs to fix Lisfranc ligamentous injuries. Fixation with a suture button construct has the theoretical advantage of allowing some motion across the Lisfranc joint which is thought to be more consistent with the joint’s normal anatomy. Fixation of the Lisfranc fracture or ligament injury is typically performed through an incision between the first and second toes at the level of the midfoot, centered over the joint between the second metatarsal and medial cuneiform. The joint and any fractures are placed back into their normal position, and fixation occurs through one of three methods: fixing with plates and screws, fusing, or fixation with a suture button construct. Plate and screw fixation can be performed with several different shapes and sizes of plates, with the ultimately goal of returning all joints and fractures to normal position. Fusion can be performed with either plates and screws or with a larger screw down the middle of the bone. Suture button fixation is performed by drilling a hole between the second metatarsal and medial cuneiform in line with the joint. A suture button is passed through this hole and tightened to ensure secure fixation. After all of these forms of fixation patients are placed into a splint or a boot and are not allowed to put weight on their foot for upwards of 2 months.