The Effect of Suture-Button Fixation on Simulated Syndesmotic Malreduction: A Cadaveric Study

Abstract

Although the clinical relevance is unknown, dynamic syndesmotic fixation may mitigate clamp-induced malreduction.

Current trends in the diagnosis and management of syndesmotic injury

“…They found that with anterior offaxis clamping, the mean sagittal malreduction was 2.7 ± 2.0 mm with screw fixation and 1.0 ± 1.0 mm with suture button fixation. They also found a difference in posterior off-axis clamping; the sagittal malreduction was 7.2 ± 2.3 mm with screw fixation and .05 ± 1.4 mm with suture button fixation [58]. They concluded that suture button fixation of the syndesmosis results in less postoperative displacement in comparison to the more traditional screw fixation.…”

“…Some limited investigations have attempted to compare dynamic suture button fixation with syndesmotic screw fixation [54,[57][58][59][60][61][62]. Westermann et al performed a cadaveric study to see if there was a difference in the malreduction of syndesmotic injuries when comparing screw fixation with tightrope fixation [58].…”

“…Westermann et al performed a cadaveric study to see if there was a difference in the malreduction of syndesmotic injuries when comparing screw fixation with tightrope fixation [58]. They found that with anterior offaxis clamping, the mean sagittal malreduction was 2.7 ± 2.0 mm with screw fixation and 1.0 ± 1.0 mm with suture button fixation.…”

Acute and Chronic Injuries to the Syndesmosis

“…[130][131][132][133][134][135][136][137][138][139][140][141][142][143][144] A hole is drilled through the fibula and tibia, and then a suture is passed through and secured on both ends via a metallic button. Systematic reviews of low levels of clinical evidence have demonstrated similar functional outcomes, with quicker return to work and less frequent need for implant removal.…”

“…Because of this, dynamic implants have been investigated in malreduced cadaveric models and have been shown to mitigate clamp-induced malreduction in the coronal and sagittal planes. 144 By improving the reduction, the surgeon can hopefully maximize patient outcomes and minimize need for secondary interventions.…”