Comparative clinical outcomes of K-wire fixation versus screw fixation in Lisfranc joint injuries: A multicenter (TRON group) retrospective study

Abstract

Treatment of Lisfranc joint injuries commonly involves surgical fixation, with screw fixation and Kirschner wire (K-wire) fixation being two primary methods. However, the optimal fixation strategy remains debated, particularly regarding functional outcomes and complications. This multicenter retrospective study analyzed 50 patients (25 per group) who underwent either screw or K-wire fixation for Lisfranc injuries between 2014 and 2024. Patients were matched by age and sex. Outcomes were assessed using AOFAS midfoot scores, complication rates, and radiographic evaluation. Operative time was significantly shorter in the K-wire group (41.0 vs. 118.5 min, p < 0.001). AOFAS scores showed no significant difference between groups (median of 88.0 vs. 90.0, p = 0.84). The K-wire group showed higher rates of malunion (28.0 % vs. 4.0 %, p = 0.049), whereas the screw group had increased rates of implant breakage (12.0 %, p = 0.012), wound irritation (36.0 %, p = 0.095), and unplanned implant removal (28.0 %, p < 0.001). Both fixation methods achieved comparable functional outcomes, which were assessed in patients who were followed for at least 90 days. K-wire fixation offered advantages in shorter operative time and fewer hardware-related complications but showed higher rates of malunion. Treatment choice should be individualized based on patient factors and injury characteristics, with K-wire fixation representing a viable alternative in appropriate cases.