The Effect of Varying Tension of a Suture Button Construct in Fixation of the Tibiofibular Syndesmosis—Evaluation Using Stress Computed Tomography

Background: The diagnosis of subtle injuries to the distal tibiofibular syndesmosis remains elusive. Conventional radiographs miss a large subset of injuries that present without frank diastasis. This study evaluated the impact of torque application on the assessment of syndesmotic injuries when using weightbearing computed tomography (CT) scans. Methods: Seven pairs of male cadavers (tibia plateau to toe-tip) were included. CT scans with axial load application (85 kg) and with (10 Nm) or without torque to the tibia (corresponding to external rotation of the foot and ankle) were taken during 4 test conditions. First, intact ankles (native) were scanned. Second, 1 specimen from each pair underwent anterior inferior tibiofibular ligament (AITFL) transection (condition 1A), while the contralateral underwent deltoid transection (condition 1B). Third, the lesions were reversed on the same specimens and the remaining intact deltoid or AITFL was transected (condition 2). Finally, the distal tibiofibular interosseous membrane (IOM) was transected in all ankles (condition 3). Measurements were performed to assess the integrity of the distal tibiofibular syndesmosis on digitally reconstructed radiographs (DRRs) and on axial CT scans. Results: Torque impacted DRR and axial CT scan measurements in almost all conditions. The ability to diagnose syndesmotic injuries using axial CT measurements improved when torque was applied. No significant syndesmotic morphological change was observed with or without torque for either isolated AITFL or deltoid ligament transection. Discussion: Torque application had a notable impact on two-dimensional (2-D) measurements used to diagnose syndesmotic injuries for both DRRs and axial CT scans. Because weightbearing conditions allow for standardized positioning of the foot while radiographs or CT scans are taken, the combination of axial load and torque application may be desirable. Clinical Relevance: Application of torque to the tibia impacts 2-D measurements and may be useful when diagnosing syndesmotic injuries by DRRs or axial CT images.

Download Full-text

Dunking the Knot in Suture Button Fixation for Distal Tibiofibular Syndesmosis Injury: Technique Tip

Foot & Ankle International ◽

10.3113/fai.2012.0686 ◽

2012 ◽

Vol 33 (8) ◽

pp. 686-688 ◽

Cited By ~ 2

Author(s):

Dylan J. Watson ◽

Brian A. Weatherby ◽

John W. Womack

Keyword(s):

Tibiofibular Syndesmosis ◽

Suture Button ◽

Distal Tibiofibular Syndesmosis ◽

Syndesmosis Injury

Download Full-text

Comparison of outcome following operative fixation of the distal tibiofibular syndesmosis with diastasis screw and suture button techniques

Injury Extra ◽

10.1016/j.injury.2012.07.247 ◽

2012 ◽

Vol 43 (10) ◽

pp. 89

Author(s):

B. Johnson ◽

S. Kumar ◽

A. Sinha

Keyword(s):

Tibiofibular Syndesmosis ◽

Suture Button ◽

Distal Tibiofibular Syndesmosis ◽

Operative Fixation

Download Full-text

Comparison of Different Fixation Methods of the Suture-Button Implant for Tibiofibular Syndesmosis Injuries

The American Journal of Sports Medicine ◽

10.1177/0363546511413455 ◽

2011 ◽

Vol 39 (10) ◽

pp. 2226-2232 ◽

Cited By ~ 61

Author(s):

Atsushi Teramoto ◽

Daisuke Suzuki ◽

Tomoaki Kamiya ◽

Takako Chikenji ◽

Kota Watanabe ◽

...

Keyword(s):

Tibiofibular Syndesmosis ◽

Fixation Methods ◽

Suture Button

Download Full-text

PO 18198 - Treatment of distal tibiofibular syndesmosis injury in ankle fractures with suture button

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1031 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 43S

Author(s):

Guilherme Honda Saito ◽

Marcelo Pires Prado ◽

Alberto Abussamra Moreira Mendes ◽

Danilo Ryuko Nishikawa ◽

Beatriz Devito ◽

...

Keyword(s):

Hardware Removal ◽

Ankle Fractures ◽

Tibiofibular Syndesmosis ◽

Aofas Score ◽

Patient Functioning ◽

Suture Button ◽

Distal Tibiofibular Syndesmosis ◽

Tibiofibular Joint ◽

The Mean

Introduction: Distal tibiofibular syndesmosis (DTFS) injuries in ankle fractures are conventionally treated by DTFS fixation with stabilizing screws. However, screws may cause problems due to their inherent rigidity. Therefore, the popularity of fixation devices that allow DTFS mobility has increased. The objective of the present study is to describe the outcomes of the surgical treatment of ankle fractures with DTFS injury using suture button syndesmosis fixation. Methods: Forty-four patients surgically treated with a suture button for ankle fractures associated with DTFS injury were retrospectively analyzed. The mean follow-up time was 14.7 months. Patient functioning was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale (VAS), the rate of complications and the need for reoperation. Results: The mean AOFAS score at the last follow-up visit was 92 (35-100). The mean VAS was 0.8 (0-7). Eight patients (18%) developed complications, the most common of which were posttraumatic osteoarthrosis and peroneal tendinopathy. Reoperations were performed in 6 patients (13.5%) and included orthopedic hardware removal, peroneal tenoplasty, neurolysis or distal tibiofibular arthrodesis. Only one patient was unable to resume previous activities. Conclusion: Suture button is a reliable alternative for DTFS fixation in ankle fractures, providing excellent functional outcomes with a low rate of complications. This device has the theoretical advantage of allowing physiological mobility of the distal tibiofibular joint and generally requires no subsequent orthopedic hardware removal.

Download Full-text