Does the choice of syndesmotic screw versus suture button in ankle surgery has a silver lining? – a technical note

Abstract

Purpose Unstable ankle fractures with associated syndesmotic injury are of considerable morbidity in the professional athlete population. The use of dynamic suture button versus static syndesmotic screws fixation, rehabilitation protocols and timing to return to play are still areas of debate. We report the use of novel algorithm of sequential static and dynamic syndesmotic fixation in an elite football player with Weber C ankle fracture. Methods The patient underwent open reduction and internal fixation for a weber C ankle fracture with associated syndesmotic and deltoid ligament injury. The osteosynthesis included lateral malleolus neutralizing plate, two syndesmotic screws and deltoid anchor repair. At 6 weeks post-operative both syndesmotic screws were removed and one suture button was implanted in the proximal screw hole. After the second operation the patient was allowed full weight bearing and range of motion in all direction with accelerated rehabilitation protocol. Results The technique provided satisfactory results. At 4 month the player participated in a 90 min official football match. The fracture healed uneventfully with no recurrent syndesmotic diastasis. Conclusion The presented technique of sequential dynamic and static fixation of associated syndesmotic injuries combined advantages of both syndesmotic screws and suture button implants. In an aim to allow earlier return to play in an elite football player. This opens the way for higher level of evidence clinical trials.

A retrospective study of deltoid ligament repair versus syndesmotic fixation in lateral malleolus fracture combined with both deltoid ligament injury and inferior tibiofibular syndesmotic disruption

“…In addition, screw syndesmotic fixation alters physical biomechanical movement, which needs additional surgery to remove fixation screws. Therefore, more anatomic methods such as tightrope fixation, suture button fixation, etc., for the syndesmotic fixation were carried out and obtained better clinical outcomes compared with screw syndesmotic fixation ( 9 , 10 , 18 – 20 ). In the other side, recently, the importance of deltoid ligament for the stability of ankle has been identified, and it is believed that repairing injured deltoid ligament at the time of fracture stabilization will obtain better ankle stabilization ( 11 , 21 , 22 ).…”

“…For operative treatment of lateral malleolus fracture, open reduction and internal fixation (ORIF) is usually suggested. Syndesmotic fixation was first used to stabilize inferior tibiofibular syndesmosis and recover the tibiotalar contact area (7); however, the high occurrence rate of malreduction of the tibiofibular syndesmosis and the need for an extra procedure for removing syndesmotic screws were observed by surgeons (7)(8)(9)(10). Therefore, deltoid ligament repair was carried out as a more anatomic method to recover the tibiotalar contact area (11).…”

Treatment of Maisonneuve fractures using a plate, TightRope® syndesmosis fixation, and arthroscopic assistance

“…A recent study has shown that it may be useful to first perform an operation with a one-third tubular plate on the fibula and two trans-syndesmotic screws so that the bones can heal properly, with this being replaced at six weeks with a double TightRope to allow full weight-bearing and articulation while avoiding the risk of tibiofibular diastasis and simultaneously allowing the syndesmosis time to repair properly 27 . However, this would inevitably lead to increased costs because of the need for a second surgery 28 .…”

El peroné flotante: Resultado de una luxación tibioastragalina pura con lesión de la articulación tibioperonea proximal: Reporte de caso

“…Además, los pacientes con lesiones sindesmóticas tratados con esta técnica tienen una recuperación funcional y reincorporación al trabajo más rápida y una rehabilitación más corta que los pacientes tratados con tornillos. [14][15][16][17]…”

“…Moreover, patients with syndesmotic injuries treated with this technique experience a faster functional recovery and return to work, as well as shorter periods of rehabilitation, than patients treated with screws. [14][15][16][17]…”