Risk factors for screw breakage in Lisfranc joint injuries: A multicenter retrospective study

Lisfranc joint injuries are rare but significantly impact foot biomechanics. Open reduction and internal fixation (ORIF) using screws is common, but screw breakage is a frequent issue. While previous studies have reported breakage rates, few have investigated the association between screw type and breakage risk.

This study aims to identify risk factors for screw breakage, analyze the timing and patterns of failures, and evaluate their impact on clinical outcomes.

Multicenter retrospective cohort study.

This multicenter retrospective study analyzed 233 patients who underwent surgical treatment for Lisfranc injuries at 11 institutions between January 2014 and June 2024. After applying the exclusion criteria, 72 patients were eligible for inclusion in the study. These patients were divided on the basis of screw type (cannulated [n = 31] and solid [n = 41]). Following age- and sex-matching, 48 patients were selected (Group C: cannulated, n = 24; Group S: solid, n = 24).

Screw breakage occurred more frequently in Group C (28.6 %) than in Group S (3.6 %) (p = 0.004). The median time to breakage was 39 weeks (range: 8-54). Logistic regression analysis revealed that usage of cannulated screws was a significant risk factor for breakage (OR 0.132, 95 % CI 0.0252-0.694; p = 0.0167). Despite higher breakage rates, Group C had better final AOFAS scores (median 95.00 vs. 90.00, p = 0.031). Among the 11 broken screws, 7 (63.6 %) were retained without adverse effects on functional outcomes.

Cannulated screws were associated with increased breakage risk in Lisfranc injuries, although this did not negatively impact functional outcomes.