Flexible stabilization of the distal tibiofibular syndesmosis: clinical and biomechanical considerations: a review of the literature (original) (raw)
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The archives of bone and joint surgery, 2018
Background The importance of the syndesmosis in ankle stability is well recognized. Numerous means of fixation have been described for syndesmotic injuries including the suture button technique. Significant cost limits the use the commercially available options. We, therefore, designed a cheap and readily available alternative construct. We aim to assess the results of using a novel suture-button construct in treatment of syndesmotic ankle injuries. Methods Fifty-two patients (34 males and 18 females) fulfilled our inclusion/exclusion criteria. Five patients were lost to follow-up. The remaining 47 patients were successfully followed up for a minimum of 24 months. The pre and post-surgery American Orthopedic Foot and Ankle Society scores (AOFAS) together with reported complications and post-operative radiological analysis were assessed. In this innovative construct, we utilized polyester braided surgical sutures jointly with double mini two- holed plates, a No.2 polygalactin 910 sut...
Injury, 2021
Objective: Randomised controlled trials (RCT) with short-term follow-ups have shown that, in treatment of syndesmosis injuries, a suture button device (SB) resulted in better radiographic and functional outcome compared to syndesmosis screw fixation (SS). However, only one RCT has reported long-term results; thus, the syndesmosis malreduction rates for both implants might increase during longer follow-up. The primary objective of this RCT was to evaluate the maintenance of syndesmosis reduction with the SS compared to the SB fixation in patients during a minimum follow-up of 6-years. The secondary objectives were to assess the post-traumatic osteoarthritis (OA) grade and the functional outcome.
Biomechanical Comparison of 3 Syndesmosis Repair Techniques With Suture Button Implants
Orthopaedic Journal of Sports Medicine
Background: Suture button fixation of syndesmotic injury is growing in popularity, as it has been shown to provide adequate stability in a more cost-effective manner than screw fixation while allowing more physiologic distal tibiofibular joint motion. However, the optimal repair technique and implant orientation have yet to be determined. Purpose/Hypothesis: The purpose of this study was to biomechanically compare 3 suture button construct configurations/ orientations for syndesmosis fixation: single, parallel, and divergent. The authors hypothesized that all 3 methods would provide adequate stabilization but that the divergent technique would be the most stable. Study Design: Controlled laboratory study. Methods: The fixation strengths of 3 stabilization techniques with suture button devices were compared with 10 cadaveric legs each (N ¼ 30). Ankle motion under cyclic loading was measured in multiple planes: first in the intact state, then following simulated syndesmosis injury, and then following fixation with 1 of 3 randomly assigned constructs-1 suture button, 2 suture buttons in parallel, and 2 divergent suture buttons. Finally, axial loading with external rotation was applied to failure. Results: All syndesmotic fixation methods provided stability to the torn state. There was no statistically significant difference among the 3 fixation techniques in biomechanical stability. Failure most commonly occurred through fibular fracture at supraphysiologic loads. Conclusion: Suture button implant fixation for syndesmotic injury appears to provide stability to the torn syndesmosis, and the configuration of the fixation does not appear to affect the strength or security of the stabilization. Clinical Relevance: This study provides further insight into the biomechanics and optimal configuration of suture button fixation of the torn syndesmosis. Based on these results, the addition of a second suture button may not significantly contribute to immediate postoperative stability.
Foot and Ankle Surgery, 2021
Background: To compare biomechanically metal screw fixation to suture-button or bioabsorbable screw fixation for ankle syndesmotic injuries. Methods: A literature search of the comparison studies in Pubmed and Google Scholar was conducted. The biomechanical outcomes of interest were syndesmotic stability in the coronal, sagittal, and axial planes as well as torque and rotation at failure. Results: A total of 11 cadaveric studies were included. In the suture-button group, coronal displacement (MD 1.72 mm, p = 0.02) and sagittal displacement (MD 2.65 mm, p = 0.0003) were increased relative to the metal screw group. In contrast, no difference was found with axial rotation (MD 0.35 degrees, p = 0.57). Bioabsorbable screws exhibited equivalent failure torque (MD À3.04 Nm, p = 0.53) and rotation at failure (MD 3.77 degrees, p = 0.48) in comparison to metal screws. Conclusions: Suture-button provide less rigidity when compared to metal screw fixation. They afford flexible syndesmotic micromotion which may more closely resemble a physiological state and be helpful for ligament healing. Bioabsorbable screws demonstrate similar mechanical strength properties to metal screws.
International Journal of Orthopaedics, 2020
AIM: To compare functional outcomes and adverse events of surgically treated syndesmotic injuries with either screw(s) or suturebutton(s). It was hypothesized that suture-button fixation would provide equal clinical results with fewer adverse events. MATERIALS AND METHODS: Multi-center, randomized clinical study. Sixty-five subjects with confirmed acute syndesmotic injury requiring surgical intervention were enrolled. Subjects were randomized and treated with either suture-button or screw fixation. Foot and Function Index pain, disability, and activity scores, American Orthopaedic Foot and Ankle Society scores, and the Visual Analogue Scale for pain were reported up to 12-months. The adverse events were also collected. The forty subjects with complete data up to one year (n = 40; suture-button = 18 and screw = 22) were included in analysis. Single or multiple screws or suture-button implants were based on surgeon preference and patients' characteristics. RESULTS: There was statistically significant improvement in Foot and Function Index and American Orthopaedic Foot and Ankle Society scores with both techniques (p < 0.05). Visual Analog Scale scores improved significantly with the screw technique (p < 0.05) but not with the suture button technique. CONCLUSION: One-year clinical data suggests that acute syndesmotic injuries can be effectively treated with either technique. A possible benefit of suture button fixation may be a lower occurrence of adverse clinical events.
Management of syndesmotic injuries of the ankle
EFORT Open Reviews, 2017
Injuries to the tibioperoneal syndesmosis are more frequent than previously thought and their treatment is essential for the stability of the ankle mortise. Recognition of these lesions is essential to avoid long-term morbidity. Diagnosis often requires complete history, physical examination, weight-bearing radiographs and MRI. Treatment-oriented classification is mandatory. It is recommended that acute stable injuries are treated conservatively and unstable injuries surgically by syndesmotic screw fixation, suture-button dynamic fixation or direct repair of the anterior inferior tibiofibular ligament. Subacute injuries may require ligamentoplasty and chronic lesions are best treated by syndesmotic fusion. However, knowledge about syndesmotic injuries is still limited as recommendations for surgical treatment are only based on level IV and V evidence. Cite this article: EFORT Open Rev 2017;2:403–409. DOI: 10.1302/2058-5241.2.160084
Foot and Ankle Surgery, 2022
The clinical relevance and treatment of syndesmosis injury in supination-external rotation (SER) ankle fractures are controversial. Methods: After malleolar fixation 24 SER 4 ankle fracture patients with unstable syndesmosis in external rotation stress test were randomised to syndesmosis transfixation with a screw (13 patients) or no fixation (11 patients). Mean follow-up time was 9.7 years (range, 8.9-11.0). The primary outcome measure was the Olerud-Molander Ankle Outcome Score (OMAS). Secondary outcome measures included ankle mortise congruity and degenerative osteoarthritis, 100-mm visual analogue scale for function and pain, RAND 36-Item Health Survey, and range of motion. Results: Mean OMAS in the syndesmosis transfixation group was 87.3 (SD 15.5) and in the nosyndesmosis-fixation group 89.0 (SD 16.0) (difference between means 1.8, 95% CI À10.4-14.0, P = 0.76). There were no differences between the two groups in secondary outcome measures. Conclusion: With the numbers available, SER 4 ankle fractures with unstable syndesmosis can be treated with malleolar fixation only, with good to excellent long-term functional outcome.
Management of distal tibio-fibular syndesmotic injuries : A snapshot of current practice
2008
Management of syndesmotic injuries of the ankle remains controversial. A postal questionnaire was administered to 310 Orthopaedic consultants in the United Kingdom to explore these issues. One hundred and ninety seven (63.55%) replies were received. A large number of surgeons use intra-operative hook test as an aid to assess syndesmotic stability (68.8%). A clear majority favoured the use of a syndesmotic screw as the preferred method of fixation (97.4%). The opinion on technique was divided over issues including number of cortices fixed, position and type of screw used. Most surgeons (88.4%) do not compress the syndesmosis while inserting the screw. Very few surgeons (8.5%) allow full weight bearing immediately after surgery. The survey establishes an overview of current practice of management of syndesmotic ankle injuries.
The management of syndesmotic screw in ankle fractures
Acta bio-medica : Atenei Parmensis, 2018
BACKGROUND AND AIM There is a wide debate about the number, diameter and length of the syndesmotic screw and necessity and timing for its removal. The aim of this study is to determine whether functional and radiological outcomes differ in patients operated for Weber type B and C ankle fractures who had syndesmotic screws removed (group 1) compared to those who did not (group 2). Furthermore, authors want to define if it is really necessary to remove this device and its correct timing. MATERIALS AND METHODS 90 patients were eligible for the study. The functional outcomes were analyzed 1 year after surgery using OMAS and AOFAS scores. Radiographic evaluation assessed the tibiofibular distance immediately and 12 months after surgery and fracture's healing. RESULTS Clinical and x-rays results were similar in both groups at follow-up. DISCUSSION Fractures with interruption of syndesmosis are lesions that, if not well treated, are complicated by joint stiffness, residual pain and pos...