Bioabsorbable screws for reduction of Lisfranc's diastasis in athletes

This was a study of 15 athletes who sustained Lisfranc's diastasis and were treated with surgical reduction and fixation with 3.5mm bioabsorbable poly-L lactic acid screws. Patients were prospectively evaluated for their ability to return to activity, maintenance of reduction, and need for implant removal. The average patient age was 28 years; there were 9 females and 6 males. Average followup was 36 months (range: 12-62). The mean return to activity time was 4.2 months (range: 3-6), with a significant difference between males and females (P=.02), 3.4 versus 4.7 months, respectively. The mean preoperative American Orthopedic Foot and Ankle Society midfoot score was 35.4+/-25.0, which increased postoperatively to 92.7+/-7.7 (P=.00001). Overall there were 10 "excellent," 4 "good," and 1 "poor" result. Patients were statistically more likely to have less than an excellent result when diagnosis was delayed by more than 6 weeks (P=0.01). One patient demonstrated a radiographic loss of reduction but returned to full sports activities. The patient with the longest delay in diagnosis demonstrated anatomic reduction but exhibited radiographic degenerative changes and scored a poor result. Three patients required a second surgery for screw or screw head removal. Bioabsorbable screws appear sufficient for treating Lisfranc's diastasis but do not necessarily obviate fixation removal.