A 10-Year Follow-Up of Ankle Syndesmotic Injuries: Prospective Comparison of Knotless Suture-Button Fixation and Syndesmotic Screw Fixation

Altmeppen, Jan; Colcuc, Christian; Balser, Christian; Gramlich, Yves; Klug, Andreas; Neun, Oliver; Manegold, Sebastian; Hoffmann, Reinhard; Fischer, Sebastian

doi:10.3390/jcm11092524

Cited by 12 publications

(15 citation statements)

References 45 publications

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“…Our results also showed that the rate of malreduction in the sagittal plane was more frequent than in the coronary direction in the SYS and SBS [ 29 , 38 ]. The rate of malreduction appears to be lower with the use of SBS than with SYS, which is considered a factor for tendentially better clinical outcomes after SBS [ 5 , 15 , 17 , 27 , 42 – 44 ]. Based on mathematical considerations, which are supported by the studies mentioned above, FNF might represent a possible approach to explain the trend towards better radiological and clinical outcomes after SBS [ 27 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to stabilization using a static syndesmotic screw (SYS), which has been performed for decades, stabilization with a suture button system (SBS) was introduced in the 2000s [ 11 , 12 ]. This has proven to be an effective method for stabilizing isolated as well as fracture associated syndesmosis injuries and has become more established in recent years [ 4 , 5 , 13 – 16 ]. SBS tends to lower the rates of malreduction and results in better early postoperative functional outcomes; however, which method should be preferred has not yet been conclusively clarified [ 5 , 10 , 15 , 17 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…This has proven to be an effective method for stabilizing isolated as well as fracture associated syndesmosis injuries and has become more established in recent years [ 4 , 5 , 13 – 16 ]. SBS tends to lower the rates of malreduction and results in better early postoperative functional outcomes; however, which method should be preferred has not yet been conclusively clarified [ 5 , 10 , 15 , 17 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

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“Flexible nature of fixation” in syndesmotic stabilization of the inferior tibiofibular joint affects the radiological reduction outcome

Hennings¹,

Fuchs²,

Spiegl³

et al. 2022

International Orthopaedics (SICOT)

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Purpose Fibular mobility after suture button stabilization (SBS) of inferior tibiofibular joint (syndesmosis) injuries has been described. This effect is called the “flexible nature of fixation (FNF).” In this study, we aimed to quantify FNF in syndesmotic stabilization. Methods Postoperative bilateral computed tomography (CT) of ankle fractures with syndesmosis stabilization by SBS or syndesmotic screw (SYS) was retrospectively analyzed. The transverse offset (TO) and vertical offset (VO) were defined by evaluating the drill channels. The reduction outcome was evaluated by the side-to-side difference between the clear space and the anterior tibiofibular distance (antTFD). The calculated anterior tibiofibular distance (cal-antTFD) was calculated by subtracting the TO from the validated antTFD. Subsequently, a reevaluation of the reduction outcomes after SYS or SBS stabilization was performed using cal-antTFD. Results Sixty patients (44 with SBS and 16 with SYS stabilization) were analyzed. The intra-rater and inter-rater reliabilities for TO and VO were excellent (α > 0.92). SYS stabilization showed lower mean TO (− 0.02 mm; SD 0.14) and VO (0.11 mm; SD, 0.29 mm) than SBS stabilization (TO 1.16 mm, SD 1.4 mm; VO 0.2 mm, SD 0.8 mm; p = 0.001). The rate of malreduction according to cal-antTFD was higher than that of antFTD (p = 0.033). Conclusion The presented method, which evaluates the position of the tibial to the fibular drill channel, allowed the quantification of the “FNF.” The often described difference in the dynamic stabilization of SBS compared to the rigid stabilization by SYS could be objectified. Considering cal-antTFD illustrates that FNF potentially reduces the rate of malreduction in SBS stabilization.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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“Flexible nature of fixation” in syndesmotic stabilization of the inferior tibiofibular joint affects the radiological reduction outcome

Hennings¹,

Fuchs²,

Spiegl³

et al. 2022

International Orthopaedics (SICOT)

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“…As a result, discomfort and joint wear may result from syndesmotic injuries that do not go through proper management. Therefore, it is crucial to restore a congruent articulating ankle with stable syndesmosis in order to avoid post-traumatic osteoarthritis, while in rare cases, syndesmosis injury may even cause serious limb-threatening complications [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Avoiding the Removal of Syndesmotic Screws after Distal Tibiofibular Diastasis Repair: A Benefit or a Drawback?

Hosin

Vermeşan

Prejbeanu

et al. 2022

JCM

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There is still no general agreement about the most effective form of syndesmosis fixation with syndesmotic screws for patients affected by ankle fractures that are accompanied by syndesmotic injuries. In the same manner, no consensus has been reached yet on whether or not the tibiofibular syndesmotic screw is more beneficial if removed or not, as well as the exact timing of removal if this proves superiority. The purpose of this research was to verify whether or not removing syndesmotic screws reduces the risk of developing a diastasis and compare outcomes in patients whose syndesmotic screw was or was not removed at all. A retrospective observational study was carried out to cover a period of five years and a computed sample size of almost 300 cases. Patients were included in the current study if their history was positive for ankle fracture with distal tibiofibular diastasis repair with syndesmotic screws. Loss of reduction was more frequent after screw removal (8.5% vs. 2.1%), although the quality of reduction was generally excellent in both groups. The mean AOFAS score was significantly better in patients who had their tibiofibular screw removed (92.6 vs. 88.4), but the tibiofibular clear space and incisura fibularis depth widened more following the second intervention (3.8 mm vs. 3.6 mm, and, respectively, 4.3 vs. 4.1). Lastly, the same patients with tibiofibular screw removal had a significantly higher cost of total interventions and more days of medical leave (21 vs. 15 days on average). It seems that a strong conclusion in favor of removing or not removing syndesmotic screws after distal tibiofibular diastasis repair cannot be given. However, several radiographic findings lean toward the benefit of those patients whose tibiofibular screws were not removed, although mobility was notably better after the screw was removed. Furthermore, treatment expenses are greatly lowered if a subsequent operation for screw removal is avoided, as well as if individuals who have a single surgery take a shorter medical leave.

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“…In misdiagnosis or inadequate treatment of syndesmotic injury, a persistent pain of the ankle, functional disability and early osteoarthritis are potential complications (4) . Thus, anatomic reconstruction of the ankle mortise, stable fixation of disrupted syndesmosis associated with an ankle fracture are essential for optimal outcome (3,5,6) .…”

Section: Introductionmentioning

confidence: 99%

Suture Button Fixation for Treatment of Acute Distal Tibiofibular Syndesmotic Injury

El-Deen

Salama

Hassan

2022

SJMS

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Introduction and Aim: Ankle fractures are common fractures encountered by the orthopedic surgeons in their daily clinical practice. The syndesmosis complex stabilizes the mortis by securing the fibula into the fibular notch. The current work aimed to evaluate the outcome of suture button fixation for treatment of distal tibiofibular syndesmotic injuries. Patients and methods: This was a quasi-experimental study. It included twenty patients with distal tibiofibular syndesmotic injury. They were operated upon by suture button fixation at Al-Azhar University Hospital (New Damietta) and were assessed clinically and radiologically directly and followed up over four months after surgery. Results: Patient’s age ranged from 25-54 years with the mean value of 39±7.3 years. Female patients were 15 (75%). The left side was 14(70%) affected in patients, while the right 6 patients (30%). The functional outcomes were 95% excellent and 5% good. There was no post-operative complication except one case complicated with superficial infection and another case complicated with wound dehiscent. All cases were operated on the same day of fracture except two cases presented by severe edema and skin bullae and the operation was delay one week until the edema subsided. Time to full weight bearing ranged 5 to 6 weeks. Conclusion: The suture button technique is considered a viable alternative option to replace screw fixation for syndesmosis injuries. It normalizes the distal tibiofibular syndesmosis that remains normal throughout the follow up duration.

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A 10-Year Follow-Up of Ankle Syndesmotic Injuries: Prospective Comparison of Knotless Suture-Button Fixation and Syndesmotic Screw Fixation

Cited by 12 publications

References 45 publications

“Flexible nature of fixation” in syndesmotic stabilization of the inferior tibiofibular joint affects the radiological reduction outcome

“Flexible nature of fixation” in syndesmotic stabilization of the inferior tibiofibular joint affects the radiological reduction outcome

Avoiding the Removal of Syndesmotic Screws after Distal Tibiofibular Diastasis Repair: A Benefit or a Drawback?

Suture Button Fixation for Treatment of Acute Distal Tibiofibular Syndesmotic Injury

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