Nitinol Staple Use in Primary Arthrodesis of Lisfranc Fracture-Dislocations
Background: Primary arthrodesis of Lisfranc fracture-dislocations is a reliable treatment option, yet concerns remain about nonunion. Nitinol staple use has recently proliferated in midfoot arthrodesis. The purpose of this study is to examine the union rate of primary arthrodesis of acute Lisfranc f...
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| Veröffentlicht in: | Foot & ankle international 2024-07, Vol.45 (7), p.690-697 |
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| creator | Dombrowsky, Alexander R. Strickland, Carson D. Walsh, Devin F. Hietpas, Kayla Conti, Matthew S. Irwin, Todd A. Cohen, Bruce E. Ellington, J. Kent Jones, Carroll P. Shawen, Scott B. Ford, Samuel E. |
| description | Background:
Primary arthrodesis of Lisfranc fracture-dislocations is a reliable treatment option, yet concerns remain about nonunion. Nitinol staple use has recently proliferated in midfoot arthrodesis. The purpose of this study is to examine the union rate of primary arthrodesis of acute Lisfranc fracture-dislocations treated with nitinol staples compared with traditional plate-and-screw fixation. The secondary objective is to assess the difference in operative times and reoperation rates.
Methods:
Midfoot fracture-dislocations treated with primary arthrodesis by 7 foot and ankle orthopaedic surgeons were reviewed. Of 160 eligible patients, 121 patients (305 joints) met the required 4-month minimum radiographic follow-up. Radiographic outcomes were analyzed at the individual joint level. Each joint was classified as either staples alone (45 patients, 154 joints), staples plus plates and screws (hybrid) (45 patients, 40 joints), or plates and screws alone (31 patients, 111 joints). The primary outcome was arthrodesis union at each joint fused.
Results:
Nonunion was more common (9.0%, 10/111) among joints fixed with plate and screws than with hybrid (2.5%, 1/40) or staples only (1.3%, 2/154) (P = .0085). Multivariable regression demonstrated that autograft use was independent associated with union (P = .0035) and plate-and-screw only fixation was an independent risk factor for nonunion (P = .0407). Median operating room and tourniquet times were shorter for hybrid (92 and 83 minutes) and staple only (67 and 63 minutes) constructs compared to plate-and-screw only fixation (105 and 95 minutes) (P ≤ .0001 and .0003). There was no difference in reoperation rates among patients with different fixation types.
Conclusion:
We found that use of nitinol compression staple and bone autograft in primary arthrodesis of Lisfranc and midfoot fracture-dislocations was associated with both improved union rates and shorter tourniquet and operative times compared to traditional plate-and-screw fixation techniques.
Level of Evidence:
Level III, therapeutic.
Graphical Abstract
This is a visual representation of the abstract. |
| doi_str_mv | 10.1177/10711007241227880 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3065983025</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_10711007241227880</sage_id><sourcerecordid>3065983025</sourcerecordid><originalsourceid>FETCH-LOGICAL-c270t-d27496284faebe063bf4e195386d2147373584ca2093984940615d36b7bc1313</originalsourceid><addsrcrecordid>eNp9kD9PwzAUxC0EolD4ACzII0uKn-34z1gVCogKkChz5DgOuErjYicD355ULSxITO-k97uT7hC6ADIBkPIaiAQgRFIOlEqlyAE6Ac15JpUUh4Me_tkWGKHTlFaEgGSgj9GIKZUTIugJenzynW9Dg187s2kcfksO-xa_RL828QtPY_cRQ-WSTzjUeOFTHU1r8Twa2_XRZTc-NcGazoc2naGj2jTJne_vGC3nt8vZfbZ4vnuYTReZpZJ0WUUl14IqXhtXOiJYWXMHOmdKVBS4ZJLliltDiWZacc2JgLxiopSlBQZsjK52sZsYPnuXumLtk3VNY1oX-lQwInKtGKH5gMIOtTGkFF1dbHbFCiDFdsLiz4SD53If35drV_06fjYbgMkOSObdFavQx3Zo-0_iN4M9dsk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3065983025</pqid></control><display><type>article</type><title>Nitinol Staple Use in Primary Arthrodesis of Lisfranc Fracture-Dislocations</title><source>MEDLINE</source><source>SAGE Journals</source><creator>Dombrowsky, Alexander R. ; Strickland, Carson D. ; Walsh, Devin F. ; Hietpas, Kayla ; Conti, Matthew S. ; Irwin, Todd A. ; Cohen, Bruce E. ; Ellington, J. Kent ; Jones, Carroll P. ; Shawen, Scott B. ; Ford, Samuel E.</creator><creatorcontrib>Dombrowsky, Alexander R. ; Strickland, Carson D. ; Walsh, Devin F. ; Hietpas, Kayla ; Conti, Matthew S. ; Irwin, Todd A. ; Cohen, Bruce E. ; Ellington, J. Kent ; Jones, Carroll P. ; Shawen, Scott B. ; Ford, Samuel E.</creatorcontrib><description>Background:
Primary arthrodesis of Lisfranc fracture-dislocations is a reliable treatment option, yet concerns remain about nonunion. Nitinol staple use has recently proliferated in midfoot arthrodesis. The purpose of this study is to examine the union rate of primary arthrodesis of acute Lisfranc fracture-dislocations treated with nitinol staples compared with traditional plate-and-screw fixation. The secondary objective is to assess the difference in operative times and reoperation rates.
Methods:
Midfoot fracture-dislocations treated with primary arthrodesis by 7 foot and ankle orthopaedic surgeons were reviewed. Of 160 eligible patients, 121 patients (305 joints) met the required 4-month minimum radiographic follow-up. Radiographic outcomes were analyzed at the individual joint level. Each joint was classified as either staples alone (45 patients, 154 joints), staples plus plates and screws (hybrid) (45 patients, 40 joints), or plates and screws alone (31 patients, 111 joints). The primary outcome was arthrodesis union at each joint fused.
Results:
Nonunion was more common (9.0%, 10/111) among joints fixed with plate and screws than with hybrid (2.5%, 1/40) or staples only (1.3%, 2/154) (P = .0085). Multivariable regression demonstrated that autograft use was independent associated with union (P = .0035) and plate-and-screw only fixation was an independent risk factor for nonunion (P = .0407). Median operating room and tourniquet times were shorter for hybrid (92 and 83 minutes) and staple only (67 and 63 minutes) constructs compared to plate-and-screw only fixation (105 and 95 minutes) (P ≤ .0001 and .0003). There was no difference in reoperation rates among patients with different fixation types.
Conclusion:
We found that use of nitinol compression staple and bone autograft in primary arthrodesis of Lisfranc and midfoot fracture-dislocations was associated with both improved union rates and shorter tourniquet and operative times compared to traditional plate-and-screw fixation techniques.
Level of Evidence:
Level III, therapeutic.
Graphical Abstract
This is a visual representation of the abstract.</description><identifier>ISSN: 1071-1007</identifier><identifier>ISSN: 1944-7876</identifier><identifier>EISSN: 1944-7876</identifier><identifier>DOI: 10.1177/10711007241227880</identifier><identifier>PMID: 38850062</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adult ; Alloys ; Arthrodesis - methods ; Bone Plates ; Bone Screws ; Female ; Fracture Dislocation - surgery ; Fracture Fixation, Internal - methods ; Humans ; Male ; Middle Aged ; Operative Time ; Radiography ; Reoperation ; Retrospective Studies ; Surgical Stapling ; Sutures</subject><ispartof>Foot & ankle international, 2024-07, Vol.45 (7), p.690-697</ispartof><rights>The Author(s) 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c270t-d27496284faebe063bf4e195386d2147373584ca2093984940615d36b7bc1313</citedby><cites>FETCH-LOGICAL-c270t-d27496284faebe063bf4e195386d2147373584ca2093984940615d36b7bc1313</cites><orcidid>0000-0003-2463-5927 ; 0000-0003-3313-2520 ; 0000-0002-4128-5618</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/10711007241227880$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/10711007241227880$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38850062$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dombrowsky, Alexander R.</creatorcontrib><creatorcontrib>Strickland, Carson D.</creatorcontrib><creatorcontrib>Walsh, Devin F.</creatorcontrib><creatorcontrib>Hietpas, Kayla</creatorcontrib><creatorcontrib>Conti, Matthew S.</creatorcontrib><creatorcontrib>Irwin, Todd A.</creatorcontrib><creatorcontrib>Cohen, Bruce E.</creatorcontrib><creatorcontrib>Ellington, J. Kent</creatorcontrib><creatorcontrib>Jones, Carroll P.</creatorcontrib><creatorcontrib>Shawen, Scott B.</creatorcontrib><creatorcontrib>Ford, Samuel E.</creatorcontrib><title>Nitinol Staple Use in Primary Arthrodesis of Lisfranc Fracture-Dislocations</title><title>Foot & ankle international</title><addtitle>Foot Ankle Int</addtitle><description>Background:
Primary arthrodesis of Lisfranc fracture-dislocations is a reliable treatment option, yet concerns remain about nonunion. Nitinol staple use has recently proliferated in midfoot arthrodesis. The purpose of this study is to examine the union rate of primary arthrodesis of acute Lisfranc fracture-dislocations treated with nitinol staples compared with traditional plate-and-screw fixation. The secondary objective is to assess the difference in operative times and reoperation rates.
Methods:
Midfoot fracture-dislocations treated with primary arthrodesis by 7 foot and ankle orthopaedic surgeons were reviewed. Of 160 eligible patients, 121 patients (305 joints) met the required 4-month minimum radiographic follow-up. Radiographic outcomes were analyzed at the individual joint level. Each joint was classified as either staples alone (45 patients, 154 joints), staples plus plates and screws (hybrid) (45 patients, 40 joints), or plates and screws alone (31 patients, 111 joints). The primary outcome was arthrodesis union at each joint fused.
Results:
Nonunion was more common (9.0%, 10/111) among joints fixed with plate and screws than with hybrid (2.5%, 1/40) or staples only (1.3%, 2/154) (P = .0085). Multivariable regression demonstrated that autograft use was independent associated with union (P = .0035) and plate-and-screw only fixation was an independent risk factor for nonunion (P = .0407). Median operating room and tourniquet times were shorter for hybrid (92 and 83 minutes) and staple only (67 and 63 minutes) constructs compared to plate-and-screw only fixation (105 and 95 minutes) (P ≤ .0001 and .0003). There was no difference in reoperation rates among patients with different fixation types.
Conclusion:
We found that use of nitinol compression staple and bone autograft in primary arthrodesis of Lisfranc and midfoot fracture-dislocations was associated with both improved union rates and shorter tourniquet and operative times compared to traditional plate-and-screw fixation techniques.
Level of Evidence:
Level III, therapeutic.
Graphical Abstract
This is a visual representation of the abstract.</description><subject>Adult</subject><subject>Alloys</subject><subject>Arthrodesis - methods</subject><subject>Bone Plates</subject><subject>Bone Screws</subject><subject>Female</subject><subject>Fracture Dislocation - surgery</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Operative Time</subject><subject>Radiography</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Surgical Stapling</subject><subject>Sutures</subject><issn>1071-1007</issn><issn>1944-7876</issn><issn>1944-7876</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kD9PwzAUxC0EolD4ACzII0uKn-34z1gVCogKkChz5DgOuErjYicD355ULSxITO-k97uT7hC6ADIBkPIaiAQgRFIOlEqlyAE6Ac15JpUUh4Me_tkWGKHTlFaEgGSgj9GIKZUTIugJenzynW9Dg187s2kcfksO-xa_RL828QtPY_cRQ-WSTzjUeOFTHU1r8Twa2_XRZTc-NcGazoc2naGj2jTJne_vGC3nt8vZfbZ4vnuYTReZpZJ0WUUl14IqXhtXOiJYWXMHOmdKVBS4ZJLliltDiWZacc2JgLxiopSlBQZsjK52sZsYPnuXumLtk3VNY1oX-lQwInKtGKH5gMIOtTGkFF1dbHbFCiDFdsLiz4SD53If35drV_06fjYbgMkOSObdFavQx3Zo-0_iN4M9dsk</recordid><startdate>202407</startdate><enddate>202407</enddate><creator>Dombrowsky, Alexander R.</creator><creator>Strickland, Carson D.</creator><creator>Walsh, Devin F.</creator><creator>Hietpas, Kayla</creator><creator>Conti, Matthew S.</creator><creator>Irwin, Todd A.</creator><creator>Cohen, Bruce E.</creator><creator>Ellington, J. Kent</creator><creator>Jones, Carroll P.</creator><creator>Shawen, Scott B.</creator><creator>Ford, Samuel E.</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2463-5927</orcidid><orcidid>https://orcid.org/0000-0003-3313-2520</orcidid><orcidid>https://orcid.org/0000-0002-4128-5618</orcidid></search><sort><creationdate>202407</creationdate><title>Nitinol Staple Use in Primary Arthrodesis of Lisfranc Fracture-Dislocations</title><author>Dombrowsky, Alexander R. ; Strickland, Carson D. ; Walsh, Devin F. ; Hietpas, Kayla ; Conti, Matthew S. ; Irwin, Todd A. ; Cohen, Bruce E. ; Ellington, J. Kent ; Jones, Carroll P. ; Shawen, Scott B. ; Ford, Samuel E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c270t-d27496284faebe063bf4e195386d2147373584ca2093984940615d36b7bc1313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Alloys</topic><topic>Arthrodesis - methods</topic><topic>Bone Plates</topic><topic>Bone Screws</topic><topic>Female</topic><topic>Fracture Dislocation - surgery</topic><topic>Fracture Fixation, Internal - methods</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Operative Time</topic><topic>Radiography</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Surgical Stapling</topic><topic>Sutures</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dombrowsky, Alexander R.</creatorcontrib><creatorcontrib>Strickland, Carson D.</creatorcontrib><creatorcontrib>Walsh, Devin F.</creatorcontrib><creatorcontrib>Hietpas, Kayla</creatorcontrib><creatorcontrib>Conti, Matthew S.</creatorcontrib><creatorcontrib>Irwin, Todd A.</creatorcontrib><creatorcontrib>Cohen, Bruce E.</creatorcontrib><creatorcontrib>Ellington, J. Kent</creatorcontrib><creatorcontrib>Jones, Carroll P.</creatorcontrib><creatorcontrib>Shawen, Scott B.</creatorcontrib><creatorcontrib>Ford, Samuel E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Foot & ankle international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dombrowsky, Alexander R.</au><au>Strickland, Carson D.</au><au>Walsh, Devin F.</au><au>Hietpas, Kayla</au><au>Conti, Matthew S.</au><au>Irwin, Todd A.</au><au>Cohen, Bruce E.</au><au>Ellington, J. Kent</au><au>Jones, Carroll P.</au><au>Shawen, Scott B.</au><au>Ford, Samuel E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nitinol Staple Use in Primary Arthrodesis of Lisfranc Fracture-Dislocations</atitle><jtitle>Foot & ankle international</jtitle><addtitle>Foot Ankle Int</addtitle><date>2024-07</date><risdate>2024</risdate><volume>45</volume><issue>7</issue><spage>690</spage><epage>697</epage><pages>690-697</pages><issn>1071-1007</issn><issn>1944-7876</issn><eissn>1944-7876</eissn><abstract>Background:
Primary arthrodesis of Lisfranc fracture-dislocations is a reliable treatment option, yet concerns remain about nonunion. Nitinol staple use has recently proliferated in midfoot arthrodesis. The purpose of this study is to examine the union rate of primary arthrodesis of acute Lisfranc fracture-dislocations treated with nitinol staples compared with traditional plate-and-screw fixation. The secondary objective is to assess the difference in operative times and reoperation rates.
Methods:
Midfoot fracture-dislocations treated with primary arthrodesis by 7 foot and ankle orthopaedic surgeons were reviewed. Of 160 eligible patients, 121 patients (305 joints) met the required 4-month minimum radiographic follow-up. Radiographic outcomes were analyzed at the individual joint level. Each joint was classified as either staples alone (45 patients, 154 joints), staples plus plates and screws (hybrid) (45 patients, 40 joints), or plates and screws alone (31 patients, 111 joints). The primary outcome was arthrodesis union at each joint fused.
Results:
Nonunion was more common (9.0%, 10/111) among joints fixed with plate and screws than with hybrid (2.5%, 1/40) or staples only (1.3%, 2/154) (P = .0085). Multivariable regression demonstrated that autograft use was independent associated with union (P = .0035) and plate-and-screw only fixation was an independent risk factor for nonunion (P = .0407). Median operating room and tourniquet times were shorter for hybrid (92 and 83 minutes) and staple only (67 and 63 minutes) constructs compared to plate-and-screw only fixation (105 and 95 minutes) (P ≤ .0001 and .0003). There was no difference in reoperation rates among patients with different fixation types.
Conclusion:
We found that use of nitinol compression staple and bone autograft in primary arthrodesis of Lisfranc and midfoot fracture-dislocations was associated with both improved union rates and shorter tourniquet and operative times compared to traditional plate-and-screw fixation techniques.
Level of Evidence:
Level III, therapeutic.
Graphical Abstract
This is a visual representation of the abstract.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>38850062</pmid><doi>10.1177/10711007241227880</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-2463-5927</orcidid><orcidid>https://orcid.org/0000-0003-3313-2520</orcidid><orcidid>https://orcid.org/0000-0002-4128-5618</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1071-1007 |
| ispartof | Foot & ankle international, 2024-07, Vol.45 (7), p.690-697 |
| issn | 1071-1007 1944-7876 1944-7876 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3065983025 |
| source | MEDLINE; SAGE Journals |
| subjects | Adult Alloys Arthrodesis - methods Bone Plates Bone Screws Female Fracture Dislocation - surgery Fracture Fixation, Internal - methods Humans Male Middle Aged Operative Time Radiography Reoperation Retrospective Studies Surgical Stapling Sutures |
| title | Nitinol Staple Use in Primary Arthrodesis of Lisfranc Fracture-Dislocations |
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