Augmenting Suture-Button Fixation for Maisonneuve Injuries With Fibular Shortening: Technique Tip

Riedel, Matthew D.; Miller, Christopher P.; Kwon, John Y.

doi:10.1177/1071100717716487

Cited by 16 publications

(10 citation statements)

References 17 publications

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“…The results are based on heterogenous studies with different numbers of implants, different diameters and cortices engaged for the screw fixation (95). A quadricortical SS is a rigid fixation, inhibiting tibiofibular movement throughout the gait cycle (97,98). The SB has a higher implant cost compared to SS (98), and may not be sufficient for maintaining fibular length in Maisonneuve fractures (97).…”

Section: Implant Choicementioning

confidence: 99%

“…A quadricortical SS is a rigid fixation, inhibiting tibiofibular movement throughout the gait cycle (97,98). The SB has a higher implant cost compared to SS (98), and may not be sufficient for maintaining fibular length in Maisonneuve fractures (97). The SB has an implant removal rate of 6%, mainly due to skin irritation from the lateral knot (99).…”

Section: Implant Choicementioning

confidence: 99%

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Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial

Ræder

Figved

Madsen

et al. 2020

The Bone & Joint Journal

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Aims In a randomized controlled trial with two-year follow-up, patients treated with suture button (SB) for acute syndesmotic injury had better outcomes than patients treated with syndesmotic screw (SS). The aim of this study was to compare clinical and radiological outcomes for these treatment groups after five years. Methods A total of 97 patients with acute syndesmotic injury were randomized to SS or SB. The five-year follow-up rate was 81 patients (84%). The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scale. Secondary outcome measures included Olerud-Molander Ankle (OMA) score, visual analogue scale (VAS), EuroQol five-dimension questionnaire (EQ-5D), range of movement, complications, reoperations, and radiological results. CT scans of both ankles were obtained after surgery, and after one, two, and five years. Results The SB group had higher median AOFAS score (100 (interquartile range (IQR) 92 to 100) vs 90 (IQR 85 to 100); p = 0.006) and higher median OMA score (100 (IQR 95 to 100) vs 95 (IQR 75 to 100); p = 0.006). The SS group had a higher incidence of ankle osteoarthritis (OA) (24 (65%) vs 14 (35%), odds ratio (OR) 3.4 (95% confidence interval (CI) 1.3 to 8.8); p = 0.009). On axial CT we measured a significantly smaller mean difference in the anterior tibiofibular distance between injured and non-injured ankles in the SB group (–0.1 mm vs 1.2 mm; p = 0.016). Conclusion Five years after syndesmotic injury treated with either SB or SS, we found better AOFAS and OMA scores, and lower incidence of ankle OA, in the SB group. These long-term results favour the use of SB when treating an acute syndesmotic injury. Cite this article: Bone Joint J 2020;102-B(2):212–219.

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Section: Implant Choicementioning

confidence: 99%

Section: Implant Choicementioning

confidence: 99%

Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial

Ræder

Figved

Madsen

et al. 2020

The Bone & Joint Journal

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“…Despite increasing use of the SB device, 20 there is a paucity of literature describing intraoperative techniques to achieve appropriate position of the device. 17,19,21 In the authors' experience, multiple factors, including a small exposure, large drill diameter required, and the irregularly shaped distal fibula, potentially contribute to risk of fibular cortical breach and resulting lateral button pull-through. The potential for lateral SB pull-through has been described either during insertion or subsequently, 17,19 but there are no specific reports of intraoperative fibular breach or techniques to avoid this complication (Figure 1).…”

Section: Getting the Starting Point Rightmentioning

confidence: 94%

Getting the Starting Point Right: Prevention of Skiving and Fibular Cortical Breach During Suture Button Placement for Syndesmotic Ankle Injuries

Kaiser

Cronin

Stenquist

et al. 2020

Foot & Ankle Specialist

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The use of suture button (SB) devices in the treatment of syndesmotic ankle injuries is increasing. These constructs have demonstrated better syndesmotic reduction, improved clinical outcomes, and lower rates of hardware removal compared with screw fixation. However, placing a SB device without a fibular plate can be technically challenging. In this technique tip, we use an illustrative case to demonstrate a technique tip that minimizes the risk of anterior or posterior cortical breach of the fibula and helps facilitate more accurate placement of a SB device. Levels of Evidence: Level V: Expert opinion

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“…8,[11][12][13][14] Meanwhile, suture-button devices have been shown to effectively treat syndesmotic injuries with a lower reported malreduction rate 12,13 but are more expensive than traditional screws 3,15 and may be inadequate for certain injury patterns that require enhanced stability (such as axially unstable injuries). 9,10,16 Although suturebuttons are increasing in usage, they were routinely used by only 14% of orthopedic surgeons in a recent survey. 6 Recent studies have demonstrated that costs associated with a secondary surgery for implant removal may make suture-button fixation more costeffective than traditional screws.…”

Section: Introductionmentioning

confidence: 99%

Syndesmotic Fixation Utilizing a Novel Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

Stenquist

Velasco

Cronin

et al. 2019

Foot & Ankle Specialist

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Background. Syndesmotic disruption occurs in 20% of ankle fractures and requires anatomical reduction and stabilization to maximize outcomes. Although screw breakage is often asymptomatic, the breakage location can be unpredictable and result in painful bony erosion. The purpose of this investigation is to report early clinical and radiographic outcomes of patients who underwent syndesmotic fixation using a novel metal screw designed with a controlled break point. Methods. We performed a retrospective review of all patients who underwent syndesmotic fixation utilizing the R3lease Tissue Stabilization System (Paragon 28, Denver, CO) over a 12-month period. Demographic and screw-specific data were obtained. Postoperative radiographs were reviewed, and radiographic parameters were measured. Screw loosening or breakage was documented. Results. 18 patients (24 screws) met inclusion criteria. The mean follow-up was 11.7 months (range = 6.0-14.7 months). 5/24 screws (21%) fractured at the break point. No screw fractured at another location, nor did any fracture prior to resumption of weight bearing; 19 screws did not fracture, with 8/19 intact screws (42.1%) demonstrating loosening. There was no evidence of syndesmotic diastasis or mortise malalignment on final follow-up. No screws required removal during the study period. Conclusion. This study provides the first clinical data on a novel screw introduced specifically for syndesmotic fixation. At short-term follow up, there were no complications and the R3lease screw provided adequate fixation to allow healing and prevent diastasis. Although initial results are favorable, longer-term follow-up with data on cost comparisons and rates of hardware removal are needed to determine cost-effectiveness relative to similar implants. Level of Evidence: Level IV: Retrospective case series

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Augmenting Suture-Button Fixation for Maisonneuve Injuries With Fibular Shortening: Technique Tip

Cited by 16 publications

References 17 publications

Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial

Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial

Getting the Starting Point Right: Prevention of Skiving and Fibular Cortical Breach During Suture Button Placement for Syndesmotic Ankle Injuries

Syndesmotic Fixation Utilizing a Novel Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

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