A Comparative Analysis of Suture-Button and InternalBrace Fixation for Purely Ligamentous Lisfranc Injuries

Purely ligamentous Lisfranc injuries are challenging to manage. Traditional open reduction and internal fixation provides rigid stability but risks cartilage damage, hardware failure, and the need for removal. Flexible fixation methods such as the suture-button (SB) and InternalBrace (IB) systems aim to maintain reduction while allowing physiological motion. This study compared clinical and radiographic outcomes of SB and IB fixation for these injuries.

A retrospective comparative study included 64 patients (SB, n = 34; IB, n = 30) with acute, purely ligamentous Lisfranc injuries and ≥24-month follow-up. Primary outcomes were American Orthopaedic Foot & Ankle Society (AOFAS) midfoot and visual analog scale (VAS) pain scores; radiographic outcomes included maintenance of the first cuneiform to second metatarsal (C1-M2) interval. Secondary measures were time to full weight bearing, return to sport, and complications.

Both groups demonstrated significant improvements in AOFAS and VAS scores from preoperative to final follow-up (P < .001). There was no statistically significant difference between the SB and IB groups in mean final AOFAS scores (92.4 vs 91.5, respectively; P = .58) or VAS scores (1.5 vs 1.2, respectively; P = .21). Both techniques effectively maintained anatomic reduction, with no significant difference in the final C1-M2 diastasis (P = .75) and no clinically significant loss of reduction at final follow-up.

SB and IB fixation provide excellent function, stable radiographic results, and low complication rates for purely ligamentous Lisfranc injuries, offering reliable alternatives to rigid fixation.