Clinical and Radiographic Outcomes Following Latarjet Using Suture Button Fixation

Background: We sought to compare the functional outcomes, radiographic outcomes, and complications of trapeziectomy and flexor carpi radialis (FCR) to abductor pollicis longus (APL) side-to-side tendon transfer with or without suture-button suspensionplasty for thumb basilar joint arthritis. Methods: Patients treated with and without suture-button suspensionplasty were compared over a 6-year period. Data were reviewed for complications and functional outcomes, including grip and pinch strength, range of motion, and visual analog scale (VAS) pain scores. Plain radiographs were independently reviewed at initial presentation and at final follow-up, including proximal phalanx length, trapezial space height, and trapezial height ratio. Results: Seventy thumb arthroplasties were performed in 70 patients. Trapeziectomy with FCR-APL side-to-side tendon transfer was performed in 39 patients, and trapeziectomy with FCR-APL side-to-side tendon transfer with suture-button suspensionplasty was performed in 31 patients. Mean length of follow-up was 28.4 ± 3.9 and 23.8 ± 2.6 months, respectively. Postoperative grip, oppositional and appositional pinch strength, and VAS pain scores improved compared with preoperative values, but were not significantly different based on suture-button suspensionplasty. Percentage decline in trapezial space ratio was significantly different between groups at 36.7% and 20.4% for procedures with and without suture-button suspensionplasty, respectively indicating that the trapezial space was better maintained within the suture suspension cohort. The incidence of postoperative complications, including surgical site infection, paresthesias, reoperation, complex regional pain syndrome, and symptomatic subsidence, was not significantly different between groups. Conclusions: Trapeziectomy with FCR to APL side-to-side tendon transfer with and without suture-button suspensionplasty results in comparable improvement in pain, grip strength, and functional parameters. Suture-button suspensionplasty results in significantly greater preservation of trapezial space.

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Screw Versus Suture Button in Treatment of Syndesmosis Instability: Clinical and Radiographic Outcomes Using PROMIS and Weight Bearing CT Scan

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00080 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0008

Author(s):

Mohamed E. Abdelaziz ◽

Noortje Hagemeijer ◽

Daniel Guss ◽

Ahmed El-Hawary ◽

A. Holly Johnson ◽

...

Keyword(s):

Ct Scan ◽

Screw Fixation ◽

Weight Bearing ◽

Pilon Fracture ◽

P Values ◽

Normal Side ◽

Suture Button ◽

Radiographic Outcomes ◽

Injured Side

Category: Ankle, Sports, Trauma, Syndesmosis Introduction/Purpose: Traumatic injuries to the distal tibiofibular syndesmosis are relatively common and can be associated with ankle fractures or occur as purely ligamentous injuries. Unstable syndesmotic injuries require surgical repair, generally performed using either screw or suture button fixation. The superiority of either fixation method remains a subject of ongoing debate. The aim of this study is to compare both clinical and radiographic outcomes of screw and suture button fixation of syndesmosis instability using Patient-Reported Outcomes Measurement Information System (ROMIS) and weight bearing CT scan (WBCT). Methods: Medical records were reviewed to identify patients who had a unilateral syndesmotic injury requiring surgical stabilization and who were at least one year out from injury. Exclusion criteria included patients less than 18 years old, ipsilateral pilon fracture, history of contralateral ankle or pilon fracture or syndesmosis injury, BMI >40, and any neurological impairment. Twenty eligible patients were recruited to complete PROMIS questionnaires and undergo bilateral WBCT scan of both ankles, divided into two groups. In the first group (n=10) the patients had undergone screw fixation of the syndesmosis, while in the second group (n=10) the syndesmosis was fixed using a suture button construct. All patients completed PROMIS questionnaires for pain intensity, pain interference, physical function and depression. Radiographic assessment was performed using axial images of WBCT scan of both the injured ankle and the contralateral normal side at a level one cm proximal to the tibial plafond (Figure 1). Results: At an average follow up of three years, none of the recruited patients required a revision surgery. There was no significant difference between the two groups in terms of the four PROMIS questionnaires (P values ranged from 0.17 to 0.43). In the suture button group, the measurements of the injured side were significantly different from the normal side for the syndesmotic area (P=0.003), fibular rotation (P=0.004), anterior difference (P=0.025) and direct anterior difference (P=0.035). Other measurements of posterior difference, middle difference, direct posterior difference and fibular translation were not significantly different (P values ranged from 0.36 to 0.99). In the screw fixation group, the syndesmotic area was the only significantly different measurement in the injured side as compared to the normal side (P=0.006). Conclusion: Screw and suture button fixation for syndesmotic instability have similar clinical outcomes at average three years follow up as measured by PROMIS scores. Both screw and suture button did not entirely restore the syndesmotic area as compared to the contralateral normal ankle, suggesting some residual diastasis on weight bearing CT. In addition, as compared to screw fixation, the suture button did not seem to restore the normal fibular rotation, with residual external rotation of the fibula noted. Longer clinical follow up is necessary to understand the clinical implication of such malreduction.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00410 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0041

Author(s):

Derek S. Stenquist ◽

Brian Velasco ◽

Patrick K. Cronin ◽

Jorge Briceno ◽

Christopher Miller ◽

...

Keyword(s):

External Rotation ◽

Case Series ◽

Break Point ◽

The Novel ◽

Suture Button ◽

Radiographic Outcomes ◽

Clear Space ◽

Anatomic Reduction ◽

Screw Breakage

Category: Ankle Introduction/Purpose: Syndesmotic disruption occurs in nearly 1 in 5 ankle fractures and requires anatomic reduction and internal stabilization to maximize functional outcomes. There is growing evidence to support retaining syndesmotic hardware from both a functional and economic standpoint. However, although broken screws are typically of little consequence, the location of screw breakage can be unpredictable and cause painful bony erosion and difficulty with extraction. The purpose of this investigation is to report early clinical and radiographic outcomes of patients who underwent syndesmotic fixation using a novel metal screw with a more predictable break point and design features to allow for easier extraction. Methods: We performed a retrospective review of all consecutive patients who underwent syndesmotic fixation utilizing the novel syndesmotic screw over a one year period. Demographic data were obtained such as age, gender, fracture classification and relevant comorbidities. Screw specific data were obtained such as number of screws utilized and length. Screw loosening or breakage was documented. Postoperative radiographs were reviewed and tibiofibular overlap, tibiofibular clear space and medial clear space were measured. Results: 18 patients met inclusion criteria. Mean length of clinical follow-up was 4.67 months (range 0.5 to 8.5 months). Per the Lauge Hansen classification, 14 injuries were supination external rotation type, two were pronation abduction and two pronation external rotation type. Three screws (12.5%) fractured at the break point with no screws fracturing at a different location. 21 screws did not fracture with 10 (42%) of the screws demonstrated to be loose. There was no evidence of syndesmotic diastasis or mortise malalignment on final follow up of the cohort. No screws required removal during the study period. There were no other complications of any type (Table 1). Conclusion: Early reporting of outcomes is essential to maximize both safety and value in healthcare technology innovation. This study provides the first clinical data on a novel alternative to traditional screws and suture button devices for fixation of syndesmotic injuries. At short-term follow up, there were no complications and the novel screw provided adequate fixation to allow healing and prevent diastasis. While initial results are favorable, longer term follow-up is required to determine whether this novel implant can reduce rates of symptomatic hardware requiring removal, which could ultimately make them more cost- effective than suture-button fixation.

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Radiographic Outcomes of Intramedullary Fixation of the Distal Fibula in Unstable Ankle Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00193 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0019

Author(s):

Connor Delman ◽

Augustine Saiz ◽

Max Haffner ◽

Aman Arora ◽

Satninderdeep Bhatti ◽

...

Keyword(s):

Treatment Strategy ◽

Case Series ◽

Intramedullary Fixation ◽

Ankle Fractures ◽

Distal Fibula ◽

Suture Button ◽

Fracture Displacement ◽

Radiographic Outcomes ◽

Clear Space ◽

Radiographic Parameters

Category: Trauma; Ankle Introduction/Purpose: Intramedullary fixation of the distal fibula in unstable ankle fractures provides an alternative treatment strategy to traditional techniques and may reduce the complication profile. While often reserved for soft-tissue protection or elderly patients, the indications for this technique continue to expand. The purpose of this study was to evaluate the radiographic outcomes of ankle fractures treated with intramedullary fixation of the distal fibula with screw or flexible fixation of the syndesmosis. Methods: A retrospective case-series was performed of patients >18 years old with unstable ankle fractures treated at a single institution. Patients were treated with intramedullary fixation of the distal fibula and screw or suture-button fixation of the syndesmosis if indicated. Radiographic parameters measured included the medial clear space, tibiofibular overlap, tibiofibular clear space, talocrural angle, and fracture displacement. Fracture pattern, comorbidities, and postoperative complications were also assessed. Results: Fourteen patients (6 males, 8 females) with torsional ankle fractures (71% SER-IV patterns) were included in the study with a mean follow-up period of 5 months. Five patients had suture-button fixation and one patient had trans-syndesmotic screw fixation of the syndesmosis. All patients had improvement in radiographic parameters following surgical stabilization. Medial clear space decreased from a mean of 5.6 +- 3.1mm to 2.8 +- 0.79mm (p<0.0001). Tibiofibular overlap increased from 0.4 +- 2.7mm to 3.0 +- 1.5mm (p<0.05). Fracture displacement of the fibula decreased from 3.5 +- 1.8mm to 0.61 +- 1mm (p<0.0001). There was no statistically significant difference between preoperative and postoperative tibiofibular clear space and talocrural angle measurements. There were no lateral wound complications, revision surgeries, or hardware complications. Conclusion: This case-series demonstrates the successful use of intramedullary fixation of distal fibula fractures in unstable ankle injuries with good radiographic and clinical outcomes. The use of an intramedullary device does not preclude trans-syndesmotic screw or suture-button fixation of concomitant syndesmotic injuries. Orthopedic surgeons can consider this treatment strategy as an alternative to traditional techniques.

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Screw Versus Suture Button in Treatment of Syndesmosis Instability: Clinical and Radiographic Outcomes Using PROMIS and Weight Bearing CT Scan

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00001 ◽

2020 ◽

Vol 5 (2) ◽

pp. 2473011420S0000

Author(s):

Mohamed Abdelaziz ◽

Daniel Guss ◽

Anne H. Johnson ◽

Christopher DiGiovanni ◽

Noortje Hagemeijer ◽

...

Keyword(s):

Ct Scan ◽

Screw Fixation ◽

Weight Bearing ◽

Pilon Fracture ◽

P Values ◽

Normal Side ◽

Suture Button ◽

Radiographic Outcomes ◽

Injured Side

Category: Trauma; Ankle; Sports Introduction/Purpose: Traumatic injuries to the distal tibiofibular syndesmosis are relatively common and can be associated with ankle fractures or occur as purely ligamentous injuries. Unstable syndesmotic injuries require surgical repair, generally performed using either screw or suture button fixation. The superiority of either fixation method remains a subject of ongoing debate. The aim of this study is to compare both clinical and radiographic outcomes of screw and suture button fixation of syndesmosis instability using Patient-Reported Outcomes Measurement Information System (PROMIS) and weight bearing CT scan (WBCT). Methods: Medical records were reviewed to identify patients who had a unilateral syndesmotic injury requiring surgical stabilization and who were at least one year out from injury. Exclusion criteria included patients less than 18 years old, ipsilateral pilon fracture, history of contralateral ankle or pilon fracture or syndesmosis injury, BMI >40, and any neurological impairment. Twenty eligible patients were recruited to complete PROMIS questionnaires and undergo bilateral WBCT scan of both ankles, divided into two groups. In the first group (n=10) the patients had undergone screw fixation of the syndesmosis, while in the second group (n=10) the syndesmosis was fixed using a suture button construct. All patients completed PROMIS questionnaires for pain intensity, pain interference, physical function and depression. Radiographic assessment was performed using axial images of WBCT scan of both the injured ankle and the contralateral normal side at a level one cm proximal to the tibial plafond ( Figure 1 ). Results: At an average follow up of three years, none of the recruited patients required a revision surgery. There was no significant difference between the two groups in terms of the four PROMIS questionnaires (P values ranged from 0.17 to 0.43). In the suture button group, the measurements of the injured side were significantly different from the normal side for the syndesmotic area (P=0.003), fibular rotation (P=0.004), anterior difference (P=0.025) and direct anterior difference (P=0.035). Other measurements of posterior difference, middle difference, direct posterior difference and fibular translation were not significantly different (P values ranged from 0.36 to 0.99). In the screw fixation group, the syndesmotic area was the only significantly different measurement in the injured side as compared to the normal side (P=0.006). Conclusion: Screw and suture button fixation for syndesmotic instability have similar clinical outcomes at average three years follow up as measured by PROMIS scores. Both screw and suture button did not entirely restore the syndesmotic area as compared to the contralateral normal ankle, suggesting some residual diastasis on weight bearing CT. In addition, as compared to screw fixation, the suture button did not seem to restore the normal fibular rotation, with residual external rotation of the fibula noted. Longer clinical follow up is necessary to understand the clinical implication of such malreduction.

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Functional and Radiographic Outcomes after the Removal of Suture-Button Fixation Device in the Treatment of Syndesmosis Diastasis

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00247 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0024

Author(s):

Jae Young Kim ◽

Jaeho Cho

Keyword(s):

Device Removal ◽

Fixation Device ◽

Aofas Score ◽

Spontaneous Reduction ◽

Suture Button ◽

Radiographic Outcomes ◽

Clear Space ◽

Before And After ◽

Postoperative Time

Category: Trauma Introduction/Purpose: Suture-button fixation device (TightRope, Arthrex, Naples, Florida) is devised to obviate the need for second operation for removal in the treatment of syndesmosis diastasis, but considerable removal rate has been reported. Nevertheless, functional and radiographic outcomes after suture-button fixation device removal has not yet been well documented. Therefore, the purpose of this study is to investigate the functional and radiographic outcomes of syndesmosis fixation treated with suture-button device before and after device removal. Methods: The records of 30 patients with syndesmosis injury who underwent suture-button fixation and later device removal between August 2009 and September 2017 were investigated. The mean postoperative time to device removal was 11.9 months (range, 7-19). In plain radiograph, tibiofibula clear space (TFCS), tibiofibula overlap (TFO), and medial clear space (MCS) were measured at three specific follow-up period; immediate postoperative (F1), just before device removal (F2), and at least three months after device removal (F3). For subgroup of 18 patients with CT scans, the Anterior to posterior (A/P) ratio (Normal range: 0.8 -1.2) was measured to investigate malreduction of syndesmosis and they were divided into two groups according to their accuracy of reduction. Additionally, functional outcomes were recorded and compared using American Orthopedic Foot and Ankle (AOFAS) score. Repeated measurement analysis of variance was performed to statistically compare the data and statistical significance was set at P < 0.05. Results: In plain radiographs, TFCS, TFO, MCS at three specific follow-up period showed no significant differences. In CT analysis at immediate postoperative period, 6 cases (30%) revealed malreduction, but 5 of them showed spontaneous reduction at follow- up just before device removal. Malreduced patients (n = 6) had a mean A/P ratio of 1.28 (range, 0.78 -1.52) at F1, 1.08 (range, 0.81- 1.21) at F2, and 1.08 (range, 0.83 -1.22) at F3 (F1, F2: p = 0.021, F1, F3: p = 0.032, F2, F3: p > 0.05). Patients with initial adequate reduction (n = 12) continued to have a reduced syndesmosis during the follow-up period and after the device removal. The AOFAS score did not change significantly before and after removal. Conclusion: Our investigation showed that the removal of suture-button device for syndesmosis fixation at average 1-year postoperative time does not bring out reduction loss or functional changes. Thus, removal is advisable for the patients with irritation or discomfort related to device. Furthermore, malreduced syndesmosis after tightrope fixation may have possibility of spontaneous reduction during the follow-up period.

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Radiographic Outcomes of Lisfranc Injuries Treated with a Suture Button Device

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00162 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0016

Author(s):

Connor Delman ◽

Christopher Kreulen ◽

Trevor Shelton ◽

Brent Roster ◽

Robert Boutin ◽

...

Keyword(s):

Screw Fixation ◽

Hybrid Technique ◽

Hybrid Fixation ◽

Suture Button ◽

Radiographic Outcomes ◽

Radiographic Measurements ◽

Second Metatarsal ◽

Significant Difference ◽

Supplemental Fixation ◽

Lisfranc Injuries

Category: Midfoot/Forefoot Introduction/Purpose: Controversy exists regarding the optimal treatment of Lisfranc injuries of the midfoot. There has been increasing interest in using a suture button device in lieu of traditional screw fixation. Biomechanical studies comparing screw fixation with suture button devices have demonstrated conflicting results. This study evaluates the radiographic outcomes of patients with Lisfranc injuries treated with a suture button device or a hybrid technique with supplemental fixation. Methods: Forty-three patients with a Lisfranc injury were treated operatively with either a suture button device (Tightrope, Arthrex, Naples, FL) or a hybrid technique with supplemental hardware fixation. The distances between the first and second metatarsal (M1-M2) and the medial cuneiform and second metatarsal (C1-M2) were measured on weightbearing radiographs. These measurements were used to assess the accuracy of reduction, maintenance of reduction, and magnitude of reduction. The accuracy of reduction was determined by comparing weightbearing AP radiographs of the uninjured foot with weightbearing radiographs of the operatively treated foot at 6 weeks postoperatively. The magnitude of reduction was assessed via a comparison of weightbearing AP radiographs of the injured foot preoperatively to the operatively treated foot at 6 weeks postoperatively. The maintenance of reduction was determined by comparing radiographic measurements at 6 weeks postoperatively to measurements taken at 12 weeks postoperatively. Results: An accurate reduction was obtained in both treatment groups with no significant difference in the M1-M2 and C1-M2 measurements at 6 weeks postoperatively compared to the uninjured foot. The magnitude of reduction was greater and statistically significant for the hybrid fixation group but was not maintained (Hybrid fixation M1-M2 magnitude of reduction: -1.39, p < .001; C1-M2 magnitude of reduction: -1.77, p < .001). The suture button treatment group attained a satisfactory reduction that was maintained with no statistically significant difference in the M1-M2 and C1-M2 distances at 6 weeks and 12 weeks postoperatively (Tightrope M1-M2 maintenance of reduction: 0.04, p=0.88; C1-M2 maintenance of reduction: 0.39, p=0.21). Conclusion: After open reduction of Lisfranc injuries, the suture button device appears to adequately maintain the reduction when patients have returned to full activity. Based on radiographic parameters, the suture button construct provides an effective alternative to traditional screw fixation for the treatment of Lisfranc injuries.

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TL 18053 - Short-term results of lisfranc injuries treated with the suture button technique

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1009 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 67S

Author(s):

Guilherme Honda Saito ◽

Alberto Mendes ◽

Danilo Nishikawa ◽

Cesar Cesar Netto ◽

Beatriz Devito ◽

...

Keyword(s):

Functional Outcomes ◽

Insertion Site ◽

Short Term ◽

Radiographic Images ◽

Suture Button ◽

Radiographic Outcomes ◽

Loss Of Reduction ◽

The Mean ◽

Lisfranc Injuries

Introduction: Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws. The aim of the present study was to provide short-term results of Lisfranc injuries treated with the suture button technique. Methods: Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated using the Mini Tight Rope® (Arthrex, Naples, FL). Medical records and radiographic images were analyzed with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up. Results: At a mean follow-up of 32 months, the average AOFAS score was 95.8 and the mean VAS was 0.6. All patients but one were able to return to their previous activities. A total of 9 complications were observed in 6 patients, with discomfort at the button insertion site being the most common (4). Other complications included evidence of radiographic arthritis (3), loss of reduction (1) and extensor hallucis longus tendinopathy (1). Only 1 patient required a reoperation for removal of the suture button. Conclusion: Use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.

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