Randomized trial comparing suture button with single 3.5 mm syndesmotic screw for ankle syndesmosis injury: similar results at 2 years

Ræder, Benedikte Wendt; Stake, Ingrid Kvello; Madsen, Jan Erik; Frihagen, Frede; Jacobsen, Silje Berild; Andersen, Mette Renate; Figved, Wender

doi:10.1080/17453674.2020.1818175

Cited by 30 publications

(34 citation statements)

References 25 publications

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“…Still, 4 studies reported on the postoperative malreduction rate based on bilateral CT imaging. 3,19,30,35 Three studies reported lower malreduction rates for the suture button group, 3,29,35 and 1 study found no differences. 30 The herein presented study highlights the previously proposed correction potential of the suture button system for both rotation and translation.…”

Section: Discussionmentioning

confidence: 98%

“… 23 , 36 Today, the authors are aware of 8 RCTs comparing suture button and syndesmotic screw fixation, with 1 study 21 presenting even a 5-year follow-up. 17 When evaluating the clinical outcome of these 8 randomized controlled trials, 3 studies found no differences 17 , 21 , 30 and 5 studies reported superior outcomes for the suture button system for at least 1 clinical outcome parameter. 3 , 7 , 29 , 35 Whether these superior results are because of a higher quality of reduction of the DTFJ remains unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous randomized controlled trials have compared the clinical outcome of suture button systems to syndesmotic screw fixation. 3 , 7 , 17 , 19 , 21 , 29 , 30 , 35 For both the patient-reported outcomes and the quality of reduction, most studies have pointed to a possible superiority of the suture button system. 3 , 17 , 19 , 29 , 35 One reason could be their above-outlined natural compensation potential for intraoperatively malreduced DTFJs, 38 also referred to as self-centering theory.…”

Section: Introductionmentioning

confidence: 99%

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Compensation of Dynamic Fixation Systems in the Quality of Reduction of Distal Tibiofibular Joint in Acute Syndesmotic Complex Injuries: A CT-Based Analysis

Spindler¹,

Gaube²,

Böcker³

et al. 2022

Foot Ankle Int.

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Background: There is an ongoing discussion on how to best stabilize syndesmotic injuries. Previous studies have indicated a better quality of reduction of the distal tibiofibular joint (DTFJ) for the suture button systems compared to syndesmotic screw fixation. Still, the reason for this superiority remains unclear. The aims of this retrospective study were to (1) analyze the deviation of the tibial and fibular drilling tunnels of the suture button system and (2) to compare these to the quality of reduction of the DTFJ assessed on bilateral postoperative CT images. Methods: Included were all adult patients who underwent syndesmotic stabilization for an acute injury using a suture button system, with postoperative, bilateral CT imaging over a 10-year period. A total of 147 patients were eligible. Based on individually reconstructed axial CT slices, the postoperative quality of reduction of the DTFJs was rated on bilateral CT images. Furthermore, the rotation and translation of the suture button drilling tunnels were analyzed. Based on these measurements, the intraoperative reduction of the DTFJ was recalculated and again rated. Using these values, the correction potential of suture button systems on the reduction of the DTFJ was analyzed. Results: (1) The drilling tunnel deviated considerably for both rotation |2.3±2.1 degrees| (range: |0.0-13.1 degrees|) and translation |0.9±0.8 mm| (range: |0-4.3 mm|). Based on the deviation of the drilling tunnels in fibula and tibia, the calculated intraoperative reduction of the DTFJ was classified as malreduced in 35.4%. (2) The DTFJ was postoperatively identified as malreduced in 17% of patients. Overall, the suture button system tended to compensate toward a more anatomical reduction both in the axial and sagittal plane. Conclusion: A suture button system postoperatively deviates and apparently has the capacity to compensate for intraoperative malreduction. Analysis of the drilling tunnels revealed that the use of a rigid fixation system would have doubled the postoperative malreduction rate.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Compensation of Dynamic Fixation Systems in the Quality of Reduction of Distal Tibiofibular Joint in Acute Syndesmotic Complex Injuries: A CT-Based Analysis

Spindler¹,

Gaube²,

Böcker³

et al. 2022

Foot Ankle Int.

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“…Looking at the AOFAS score, we found a significant improvement between the two time points. So far, no minimal clinically important difference (MCID) has been specified for ankle fractures [ 42 ]. However, considering the study of Norman et al [ 43 ] it has been assumed as half the standard deviation (SD).…”

Section: Discussionmentioning

confidence: 99%

Short‐term results of gait analysis with the Heidelberg foot measurement method and functional outcome after operative treatment of ankle fractures

Böpple

Tanner

Campos

et al. 2022

Journal of Foot and Ankle Research

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Background Ankle fractures are common fractures in trauma surgery. Several studies have compared gait patterns between affected patients and control groups. However, no one used the Heidelberg Foot Measurement Method in combination with statistical parametric mapping of the entire gait cycle in this patient cohort. We sought to identify possible mobility deficits in the tibio-talar joint and medial arch in patients after ankle fractures as a sign of stiffness and pain that could result in a pathological gait pattern. We focused on the tibio-talar flexion as it is the main movement in the tibio-talar joint. Moreover, we examined the healing progress over time. Methods Fourteen patients with isolated ankle fractures were included prospectively. A gait analysis using the Heidelberg Foot Measurement Method was performed 9 and 26 weeks after surgery to analyse the tibio-talar dorsal flexion, the foot tibia dorsal flexion, the subtalar inversion and the medial arch as well as the cadence, the walking speed and the ground reaction force. The American Orthopedic Foot & Ankle Society ankle hindfoot score was used to obtain clinical data. Results were compared to those from 20 healthy participants. Furthermore, correlations between the American Orthopedic Foot & Ankle Society hindfoot score and the results of the gait analysis were evaluated. Results Statistical parametric mapping showed significant differences for the Foot Tibia Dorsal Flexion for patients after 9 weeks (53–75%: p = 0.001) and patients after 26 weeks (58–70%: p = 0.011) compared to healthy participants, respectively. Furthermore, significant differences regarding the tibio-talar dorsal flexion for patients 9 weeks after surgery (15–40%: p < 0.001; 56,5–70%: p = 0.007; 82–88%: p = 0.033; 97–98,5%: p = 0.048) as well as patients after 26 weeks (62,5–65%: p = 0.049) compared to healthy participants, respectively. There were no significant differences looking at the medial arch and the subtalar inversion. Moreover, significant differences regarding the ground reaction force were found for patients after 9 weeks (0–17%: p < 0.001; 21–37%: p < 0.001; 41–54%: p < 0.001; 60–64%: p = 0.013) as well as patients after 26 weeks (0–1,5%: p = 0.046; 5–15%: p < 0.001; 27–33%: p = 0.001; 45–49%: p = 0.005; 57–59%: p = 0.049) compared to healthy participants, respectively. In total, the range of motion in the tibio-talar joint and the medial arch was reduced in affected patients compared to healthy participants. Patients showed significant increase of the range of motion between 9 and 26 weeks. Conclusions This study shows, that patients affected by ankle fractures show limited mobility in the tibio-talar joint and the medial arch when compared to healthy participants. Even though the limitation of motion remains at least over a period of 26 weeks, a significant increase can be recognized over time. Furthermore, if we look at the absolute values, the patients’ values tend to get closer to those of the control group. Trial registration This study is registered at the German Clinical Trials Register (DRKS00023379).

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“…The debate regarding a suture button compared with a single syndesmotic screw for stabilization of syndesmosis disruption has continued in 2 different RCTs 22,23 . Both studies utilized functional scores and radiography, including computed tomographic (CT) scans.…”

Section: Anklementioning

confidence: 99%

What’s New in Orthopaedic Trauma

Nguyen

Vallier

2021

Journal of Bone and Joint Surgery

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Randomized trial comparing suture button with single 3.5 mm syndesmotic screw for ankle syndesmosis injury: similar results at 2 years

Cited by 30 publications

References 25 publications

Compensation of Dynamic Fixation Systems in the Quality of Reduction of Distal Tibiofibular Joint in Acute Syndesmotic Complex Injuries: A CT-Based Analysis

Compensation of Dynamic Fixation Systems in the Quality of Reduction of Distal Tibiofibular Joint in Acute Syndesmotic Complex Injuries: A CT-Based Analysis

Short‐term results of gait analysis with the Heidelberg foot measurement method and functional outcome after operative treatment of ankle fractures

What’s New in Orthopaedic Trauma

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