A 24-Month Follow-Up of a Custom-Made Suture-Button Assembly for Syndesmotic Injuries of the Ankle

Abstract

In the present retrospective analysis, we introduce a custom suture-button fixation device for acute ankle syndesmotic injuries that allows for early weightbearing without another planned operation for hardware removal. We evaluated 87 consecutive ankles in 87 patients (49 males [56.32%] and 38 females [43.68%]). Of the 87 patients, 15 (17.24%) withdrew or were lost to follow-up, leaving 72 patients (82.76%) in the present study. Their mean age was 35.2 (range 17 to 67) years. Nineteen patients (26.39%) presented with a pure syndesmotic disruption, and 53 (73.61%) had associated malleolar fractures. The American Orthopaedic Foot and Ankle Society scale score improved significantly from 31.2 ± 4.2 preoperatively to 88.5 ± 5.3 at an average of 24 months postoperatively (p < .0043). Revision was undertaken because of implant failure in 4 ankles (5.56%). Two revisions (2.78%) were performed in 2 ankles because of early weightbearing in the first 2 weeks after surgery. The third patient (1.39%) underwent revision at 5 weeks postoperatively. This syndesmotic reduction failure was attributed to failure of the threads, which was noted at the second surgery. The fourth patient (1.39%), a 66-year-old male, underwent revision at 5 months postoperatively because of persistent infection. An 18-month postoperative radiograph was available for all patients. The medial clear space had significantly decreased, from 8.2 ± 3.1 mm preoperatively to 3.5 ± 2.2 mm at 18 months postoperatively (p < .0344). Likewise, the tibiofibular clear space had decreased significantly, from a mean of 8.8 ± 3.7 mm preoperatively to a mean of 3.7 ± 2.2 mm at 18 months postoperatively (p < .0322). In conclusion, suture-button fixation described in the present report delivered satisfactory functional outcomes and anatomic reduction at minimum of 18 months after surgery.

Suture Button Fixation for Treatment of Acute Distal Tibiofibular Syndesmotic Injury

“…The syndesmosis incorporates the anterior-inferior tibiofibular, posterior-inferior tibiofibular, inferior transverse tibiofibular, and the interosseous ligaments. This complex stabilizes the mortise by securing the fibula in the fibular notch (2) .…”

Comparison of Suture Button and Syndesmotic Screw for Ankle Syndesmotic Injuries: A Meta-analysis of Randomized Controlled Trials

“…1,8 Several studies have compared the advantages and disadvantages of SSs and SBs; however, it remains unclear whether the SB is preferable to the SS. 2,5,14,15 In addition, numerous systematic reviews and meta-analyses, both randomized controlled trials (RCTs) 9,27,34 and mixed RCTs and non-RCTs, 21,39,40 have been conducted to find out the best approach, but their evidence and results have varied. In the first group of reviews, 9,27,34 the included RCTs were not the latest ones, and their outcomes were insufficient; in the second group, 21,39,40 the quality of evidence was limited by the included studies.…”