Advertisement

Investigating the Radiological Outcomes of Syndesmosis Injuries in Ankle Fracture Patients After Suture Button Fixation

Published:September 18, 2021DOI:https://doi.org/10.1053/j.jfas.2021.09.013

      Abstract

      Concomitant syndesmotic injury occurs in 10% of ankle fractures. Anatomic reduction and maintenance of this reduction is critical in ensuring ankle stability and preventing long-term complications. This is a retrospective cohort study aimed at evaluating the mid-term radiological outcomes of syndesmotic injuries in ankle fracture patients after surgical fixation with suture button device. The study group included 33 patients. Plain radiographs including anteroposterior, lateral and mortise views of the affected ankle were performed preoperatively, postoperatively and at 3-month follow-up. Anteroposterior views were used to measure the amount of tibiofibular overlap and tibiofibular clear space. Paired Student's t test and linear model regression were performed. Between the immediate postoperative and 3-month follow-up period, there was a mean decrease in tibiofibular overlap of 0.841 (±2.07) mm (p = .0259). There was a mean increase in tibiofibular clear space of 0.621 (±1.46) mm (p = .0201). In addition, we found significant correlation between fracture type and change in tibiofibular clear space (p = .047). Our study showed that there is statistically significant widening of the syndesmosis after suture button fixation at 3-month follow-up as evidenced by reduced tibiofibular overlap and increase in tibiofibular clear space. However, they remain within the maximum threshold for acceptable syndesmotic widening of 1.5 mm. Further correlation between radiological outcomes and patient function is needed to determine clinical significance of these changes.

      Level of Clinical Evidence

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • van Staa TP
        • Dennison EM
        • Leufkens HG
        • Cooper C.
        Epidemiology of fractures in England and Wales.
        Bone. 2001; 29: 517
        • Schnetzke M
        • Vetter SY
        • Beisemann N
        • Swartman B
        • Grützner PA
        • Franke J.
        Management of syndesmotic injuries: what is the evidence?.
        World J Orthop. 2016; 7: 718
        • Hermans JJ
        • Beumer A
        • de Jong TA
        • Kleinrensink GJ.
        Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach.
        J Anat. 2010; 217: 633
        • Weening B
        • Bhandari M.
        Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures.
        J Orthop Trauma. 2005; 19: 102
        • Tunturi T
        • Kemppainen K
        • Pätiälä H
        • Suokas M
        • Tamminen O
        • Rokkanen P.
        Importance of anatomical reduction for subjective recovery after ankle fracture.
        Acta Orthop Scand. 1983; 54: 641
        • Ramsey PL
        • Hamilton W.
        Changes in tibiotalar area of contact caused by lateral talar shift.
        J Bone Joint Surg Am. 1976; 58: 356
        • Lloyd J
        • Elsayed S
        • Hariharan K
        • Tanaka H.
        Revisiting the concept of talar shift in ankle fractures.
        Foot Ankle Int. 2006; 27: 793
        • Xie L
        • Xie H
        • Wang J
        • Chen C
        • Zhang C
        • Chen H
        • Zheng W.
        Comparison of suture button fixation and syndesmotic screw fixation in the treatment of distal tibiofibular syndesmosis injury: a systematic review and meta-analysis.
        Int J Surg. 2018; 60: 120
        • Ræder BW
        • Figved W
        • Madsen JE
        • Frihagen F
        • Jacobsen SB
        • Andersen MR.
        Better outcome for suture button compared with single syndesmotic screw for syndesmosis injury: five-year results of a randomized controlled trial.
        Bone Joint J. 2020; 102-b: 212
        • Vopat ML
        • Vopat BG
        • Lubberts B
        • DiGiovanni CW.
        Current trends in the diagnosis and management of syndesmotic injury.
        Curr Rev Musculoskelet Med. 2017; 10: 94
        • Bai L
        • Zhou W
        • Cheng Z
        • Liu J
        • Liu P
        • Zhang W.
        A radiological study for assessing syndesmosis malreduction: its validity and limitation.
        J Foot Ankle Surg. 2020; 59: 1181
        • Rigby RB
        • Cottom JM.
        Does the Arthrex TightRope® provide maintenance of the distal tibiofibular syndesmosis? A 2-year follow-up of 64 TightRopes® in 37 patients.
        J Foot Ankle Surg. 2013; 52: 563
        • Sman AD
        • Hiller CE
        • Refshauge KM.
        Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review.
        Br J Sports Med. 2013; 47: 620
        • Murphy JM
        • Kadakia AR
        • Schilling PL
        • Irwin TA.
        Relationship among radiographic ankle medial clear space, sex, and height.
        Orthopedics. 2014; 37: e449
        • Chissell HR
        • Jones J.
        The influence of a diastasis screw on the outcome of Weber type-C ankle fractures.
        J Bone Joint Surg Br. 1995; 77-B: 435
        • Parker AS
        • Beason DP
        • Slowik JS
        • Sabatini JB
        • Waldrop 3rd., NE
        Biomechanical comparison of 3 syndesmosis repair techniques with suture button implants.
        Orthop J Sports Med. 2018; 6
        • Förschner PF
        • Beitzel K
        • Imhoff AB
        • Buchmann S
        • Feuerriegel G
        • Hofmann F
        • Karampinos DC
        • Jungmann P
        • Pogorzelski J.
        Five-year outcomes after treatment for acute instability of the tibiofibular syndesmosis using a suture-button fixation system.
        Orthop J Sports Med. 2017; 5
        • Naqvi GA
        • Cunningham P
        • Lynch B
        • Galvin R
        • Awan N.
        Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction.
        Am J Sports Med. 2012; 40: 2828
        • Thornes B
        • Shannon F
        • Guiney AM
        • Hession P
        • Masterson E.
        Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes.
        Clin Orthop Relat Res. 2005; 431: 207-212
        • Chun DI
        • Cho JH
        • Min TH
        • Park SY
        • Kim KH
        • Kim JH
        • Won SH.
        Diagnostic accuracy of radiologic methods for ankle syndesmosis injury: a systematic review and meta-analysis.
        J Clin Med. 2019; 8: 968
        • Kortekangas T
        • Savola O
        • Flinkkilä T
        • Lepojärvi S
        • Nortunen S
        • Ohtonen P
        • Katisko J
        • Pakarinen H.
        A prospective randomized study comparing tightrope and syndesmotic screw fixation for accuracy and maintenance of syndesmotic reduction assessed with bilateral computed tomography.
        Injury. 2015; 46: 1119-1126
        • Schepers T.
        Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair.
        Int Orthop. 2012; 36: 1199
        • Ibrahim IO
        • Velasco BT
        • Ye MY
        • Miller CP
        • Kwon JY.
        Syndesmotic screw breakage may be more problematic than previously reported: increased rates of hardware removal secondary to pain with intraosseous screw breakage.
        Foot Ankle Spec. 2020;
        • Manjoo A
        • Sanders DW
        • Tieszer C
        • MacLeod MD.
        Functional and radiographic results of patients with syndesmotic screw fixation: implications for screw removal.
        J Orthop Trauma. 2010; 24: 2
        • Jasqui-Remba S
        • Torres-Gómez A
        • Salas-Morales GA
        • Hernández-Martínez A.
        Changes in the radiological measurements of the tibiofibular syndesmal area in patients with Weber C ankle fractures who were treated with open reduction, internal fixation, and transyndesmal screw.
        Acta Ortop Mex. 2015; 29: 303