Syndesmotic Stabilization: Syndesmotic Screw Versus Flexible Fixation: A Systematic Review

Elabd, Ahmed; Abdullah, Samir K.; Kandel, Wael A; Hegazy, Mohamed

doi:10.1053/j.jfas.2020.09.021

Cited by 11 publications

(6 citation statements)

References 68 publications

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“…47,48 Although there were still no reports of the same experiments, suture button fixation (SBF) has better clinical effect and lower complication rate than metal screw fixation (MSF) in the fixation of syndesmotic injuries. 49,50 Mechanical Stability of TightRope ® System Fixation Furthermore, to analyze the differences in biomechanical stability among the TightRope ® system, IS screw, and TBP fixation, the displacement under loading and the ultimate load of six embalmed specimens of adult pelvises were compared and it was found that the stability of IS screw fixation was the strongest among the three fixation methods. There was no significant difference in displacement between the TBP and TightRope ® methods under vertical loads of 100 N and 200 N (P > 0.05, specific p and t values are shown in Table 5).…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, this semirigid fixation method can also ensure that the sacroiliac joint retains physiological activity and a certain degree of micromovement, so there is no need to remove the implant after surgery, and the possibility of joint stiffness will be reduced 47,48 . Although there were still no reports of the same experiments, suture button fixation (SBF) has better clinical effect and lower complication rate than metal screw fixation (MSF) in the fixation of syndesmotic injuries 49,50 …”

Section: Discussionmentioning

confidence: 99%

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Minimally Invasive Percutaneous TightRope® System Fixation for an Unstable Posterior Pelvic Ring: Clinical Follow‐up and Biomechanical Studies

Zhang

Sui

et al. 2022

Orthopaedic Surgery

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Objective To evaluate the mechanical stability and clinical efficacy of minimally invasive percutaneous TightRope® systems applied via gun‐shaped reduction forceps for unstable posterior pelvic ring fractures. Materials and methods This study consists of two parts: a clinical retrospective study and a randomized controlled biomechanical test. For the clinical study, a retrospective analysis of posterior pelvic ring fractures was performed between June 2015 and May 2020. Eighteen patients underwent surgery using two TightRope® systems to fix a broken posterior pelvic ring because of unstable AO type C1 and C2 pelvic ring fractures. The patients were followed up for at least 2 years, and all patients were evaluated using the Majeed scoring system and vertical displacement. In the biomechanical tests, six embalmed adult pelvic specimens were used. The fractures were subjected to TightRope®, IS screw, and TBP fixation in a randomized block design. The specimens were placed in a biomechanical testing machine in a standing neutral posture. A cyclic vertical load of up to 500 N was applied, and the displacement of the specimens was recorded by the testing machine. The ultimate load in each group of specimens was recorded. The displacement and ultimate load were compared and analyzed by statistical methods. Results At a mean follow‐up of 38.89 ± 8.72 months, the functional Majeed score was excellent in 14 patients and good in four patients. The final radiological examinations showed that the outcome was excellent in 14 patients and good in four patients. In these patients, no serious clinical complications were found. Weight‐bearing was delayed in four patients. In biomechanical tests, the displacement of the specimens fixed with TightRope® was significantly lower than that of the specimens fixed with TBP (P < 0.05) when the load ranged from 300 to 500 N. The displacement in the IS screw group was significantly lower than that in either the TBP or TightRope® group (P < 0.05) when the load ranged from 0 to 500 N. The ultimate load in the IS screw group (1798 ± 83.53 N) was significantly greater than that in the TBP group (1352 ± 74.41 N) (t = 9.78, P < 0.0001) and the TightRope® group (1347 ± 54.28 N) (t = 11.11, P < 0.0001). However, no significant difference was observed between the TightRope® and TBP groups (t = 0.13, P = 0.90). Conclusion Percutaneous posterior TightRope® system shows strong stability in mechanical experiments and shows good results in clinical follow‐up while this system has certain advantages in lower surgical requirements and lower risk of related nerve and vascular structural damage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Percutaneous TightRope® System Fixation for an Unstable Posterior Pelvic Ring: Clinical Follow‐up and Biomechanical Studies

Zhang

Sui

et al. 2022

Orthopaedic Surgery

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“…However, the extent to which the use of a second parallel or divergent SBS affects the FNF is still lacking. In view of this and the costs, which are lower in total than the use of a SYS and sequential material removal after 6 to 8 weeks, stabilization with one SBS is performed in our own center [ 22 ], whereby the routine removal of the SYS should be critically discussed [ 47 ]. Possible position-dependent measurement inaccuracies could be reduced by standardized positioning of the feet and exact adjustment of the CT planes but cannot be completely eliminated.…”

Section: Discussionmentioning

confidence: 99%

“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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“…J. Litrenta et al в своем рандомизированном контролируемом исследовании также подтвердили негативное влияние повреждения дистального синдесмоза на результаты хирургического лечения переломов лодыжек [21]. Во многих случаях для устранения повреждений и восстановления функции пораженного сустава необходимо хирургическое вмешательство, что в настоящее время является приоритетным методом лечения данной патологии [7,[22][23][24]. Проведено множество исследований, сравнивающих различные варианты хирургических вмешательств, например, мета-анализ A. Grassi et al на тему динамического и статического методов фиксации дистального синдесмоза, доказавший преимущество динамических видов фиксации над статическими [22].…”

Section: гений ортопедии 2024;30(1)unclassified

Intramedullary osteosynthesis for ankle fractures and distal tibiofibular syndesmotic disruption

Gafurov,

Khodzhanov,

Mansurov

et al. 2024

jour

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Introduction The optimal surgical approach for malleolar fractures and distal tibiofibular syndesmotic (DTFS) disruption remains controversial. There is no uniform treatment protocol for this type of injury.The objective was to review modern surgical treatments of the pathology and determine the optimal option.Material and methods Articles of French, English, Uzbek, Kazakh, German, Danish, Japanese and Chinese authors were retrospectively reviewed. An internet search of MedLine; PubMed; Scopus; Web of Science, CINAHL, the Cochrane Central Register of Controlled Trials databases was performed.Results Comparative studies of dynamic fixation and static fixation of the DTFS showed advantages of the dynamic methods enabling precise, anatomical syndesmotic fixation and faster healing. Dynamic fixation methods would require no implant removal, while syndesmotic screw woul be taken off to reduce compression in the ankle joint and minimize a risk of malreduction facilitating mobility of the ankle joint. Dynamic methods are associated with greater stability and less complication rate. However, static methods have the advantages of being more accessible and less expensive, which can be an important factor choosing a treatment method. Static methods are a wide application and can be used in a wide range of clinical cases. Long-term results show no statistically significant differences between dynamic fixation and static fixation.Discussion Literature review indicates the dynamic method with suture-button, a combined method and titanium cable isotonic annular fixation system as the preferred technique for surgical stabilization of distal syndesmosis associated with ankle fractures with a lower risk of postoperative complications and the possibility of short-term rehabilitation.Conclusion The choice between dynamic and static methods of distal syndesmosis fixation depends on many factors, including the complexity of the injury, the availability and cost of implants and the experience of the surgeon.

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Syndesmotic Stabilization: Syndesmotic Screw Versus Flexible Fixation: A Systematic Review

Cited by 11 publications

References 68 publications

Minimally Invasive Percutaneous TightRope® System Fixation for an Unstable Posterior Pelvic Ring: Clinical Follow‐up and Biomechanical Studies

Minimally Invasive Percutaneous TightRope® System Fixation for an Unstable Posterior Pelvic Ring: Clinical Follow‐up and Biomechanical Studies

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

Intramedullary osteosynthesis for ankle fractures and distal tibiofibular syndesmotic disruption

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