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Screw Versus Kirschner Wire Fixation in Myerson Type B Lisfranc Injuries: A Retrospective Comparative Cohort Study
Gürkan Çalışkan1, Yunus Elmas2, Orhun Çelik3
1Department of Orthopaedic Surgery and Traumatology, University of Health Sciences Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mahallesi, Turgut Özal Bulvarı No. 46/1, 34303 Küçükçekmece, Istanbul, Turkey.
Background:
Injury characteristics influence fixation choice and may also affect recovery after Lisfranc injury.
Purpose:
To compare clinical, radiographic, and plantar-pressure outcomes after screw or Kirschner wire (K-wire) fixation of Myerson type B injuries.
Study Design:
Retrospective comparative cohort study.
Methods:
Thirty-six screw-treated and 20 K-wire-treated patients were assessed after at least 12 months. Outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, Manchester-Oxford Foot Questionnaire (MOXFQ), visual analog scale (VAS) pain, Meary angle, and midfoot pressure asymmetry. Unadjusted comparisons, three regression models, and weighted sensitivity analyses were exploratory.
Results:
The screw group had more high-energy injuries (25/36 versus 8/20) and open reductions (24/36 versus 6/20). After adjustment for age, injury energy, subtype, comminution, and maximum diastasis, K-wire fixation was associated with shorter operative time (difference -16.1 minutes; 95% confidence interval -25.4 to -6.8; p < 0.001) and higher pain (+0.87 VAS points; 95% confidence interval 0.17-1.57; p = 0.015). Both associations persisted across analyses. Functional-score and pressure comparisons were inconclusive; Meary-angle estimates varied by model.
Conclusions:
K-wire fixation was associated with shorter operations and modestly higher pain. Clinical importance remains uncertain. Unmeasured injury severity, rehabilitation differences, and selective implant removal limit interpretation. These findings establish neither superiority nor equivalence and require prospective confirmation.
Level Of Clinical Evidence:
Level III (Therapeutic).
