Abstract
The optimal treatment strategy after syndesmotic injuries is still controversial.
In our study, we aimed to evaluate ideal fixation method in syndesmotic injury by
using finite element analysis method. A 3D SolidWorks model file was created by taking
computed tomography (CT) images of the area from the right foot base to the knee joint
level of a healthy adult male. The intact model, injury model, and 8 different fixation
models were created that 3.5 mm screw and suture-button were used in. The models were
compared in terms of lateral fibular translation, posterior fibular translation and
external rotation of fibula compared to tibia and stress values occurred on screws
and suture-buttons. In the hybrid-1 model, lateral fibular translation and external
fibular rotation values were obtained as close to the intact model. Von Mises stresses
occurred in the screw (435.7 MPa) and suture-button (424.7 MPa) that used in hybrid-1
model was more than single screw at 4 cm model (316.8 MPa) and single suture-button
at 2 cm model (160.7 MPa). In the Hybrid-1 model, the screw compensates for posterior
fibular translation and external fibular rotation, while the suture-button compensates
for lateral fibular translation. Also, the effect of the distal suture-button preventing
diastasis in case of proximal screw failure, it was concluded that the hybrid-1 model
can be used as a good treatment alternative in the surgical treatment of distal tibiofibular
syndesmotic injuries.
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 accessOne-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 SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention.J Orthop Sports Phys Ther. 2006; 36: 372-384
- Syndesmosis injuries in athletes.Foot Ankle Clin. 2002; 7: 529-549
- Management of syndesmosis injuries in the elite athlete.Foot Ankle Clin. 2013; 18: 195-214
- Risk factors for syndesmotic and medial ankle sprain: role of sex, sport, and level of competition.Am J Sports Med. 2011; 39: 992-998
- Management of ankle syndesmosis injuries in the athlete.Curr Sports Med Rep. 2009; 8: 228-233
- Injuries to the tibiofibular syndesmosis.J Bone Joint Surg Br. 2008; 90: 405-410
- Tricortical versus quadricortical syndesmosis fixation in ankle fractures: a prospective, randomized study comparing two methods of syndesmosis fixation.J Orthop Trauma. 2004; 18: 331-337
- Malreduction of the tibiofibular syndesmosis in ankle fractures.Foot Ankle Int. 2006; 27: 788-792
- Acute and chronic syndesmotic instability: role of surgical stabilization.Clin Sports Med. 2020; 39: 745-771
- Treatment of syndesmosis disruptions with tightrope fixation.Techniques in Foot & Ankle Surgery. 2008; 7: 196-202
- A prospective randomised study comparing TightRope and syndesmotic screw fixation for accuracy and maintenance of syndesmotic reduction assessed with bilateral computed tomography.Injury. 2015; 46: 1119-1126
- A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture.J Orthop Trauma. 2015; 29: 216-223
- Flexible fixation of syndesmotic diastasis using the assembled bolt-tightrope system.Scand J Trauma Resuscitat Emerg Med. 2013; 21: 71
- Biomechanical comparison of 3 current ankle syndesmosis repair techniques.Foot Ankle Int. 2017; 38: 200-207
- Biomechanical comparison of syndesmotic injury fixation methods using a cadaveric model.Foot Ankle Int. 2013; 34: 1710-1717
- Three-dimensional finite element analysis of the foot during standing—a material sensitivity study.J Biomech. 2005; 38: 1045-1054
- Computational simulation of fracture healing: influence of interfragmentary movement on the callus growth.J Biomech. 2007; 40: 1467-1476
- Finite element-based preclinical testing of cemented total hip implants.Clin Orthop Relat Res. 2007; 456: 138-147
- Atlas and Textbook of Human Anatomy v. 3, 1907.WB Saunders Company, 1907
- Ankle syndesmosis: a qualitative and quantitative anatomic analysis.Am J Sports Med. 2015; 43: 88-97
- The ligament anatomy of the deltoid complex of the ankle: a qualitative and quantitative anatomical study.J Bone Joint Surg Am. 2014; 96: e62
- Anatomy of the ankle ligaments: a pictorial essay.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 557-569
- Qualitative and quantitative anatomic investigation of the lateral ankle ligaments for surgical reconstruction procedures.J Bone Joint Surg Am. 2014; 96: e98
- Cadaveric analysis of the distal tibiofibular syndesmosis.Foot Ankle Int. 2016; 37: 882-890
- Dimensions and attachments of the ankle ligaments: evaluation for ligament reconstruction.Anat Sci Int. 2015; 90: 161-171
- Biomechanical characteristics of human ankle ligaments.Foot Ankle. 1985; 6: 54-58
- Tensile properties of the interosseous membrane of the human forearm.J Orthop Res. 1996; 14: 842-845
- A biomechanical evaluation of the tibiofibular and tibiotalar ligaments of the ankle.Foot Ankle Int. 2003; 24: 426-429
- The proximal tibiofibular joint: a biomechanical analysis of the anterior and posterior ligamentous complexes.Am J Sports Med. 2017; 45: 1888-1892
- Prediction of three-dimensional contact stress and ligament tension in the ankle during stance determined from computational modeling.Foot Ankle Int. 2009; 30: 177-185
- Biomechanical analysis of tibia – double threaded screw fixation.Archives of Materials Science and Engineering. 2008; 30: 41-44
- Three-dimensional finite element analysis used to compare methods of fixation after sagittal split ramus osteotomy: setback surgery-posterior loading.Br J Oral Maxillofac Surg. 2005; 43: 97-104
- Experimental validation of a finite element model of a human cadaveric tibia.J Biomech Eng. 2008; 130031016
- Acromioclavicular joint dislocation: a Dog Bone button fixation alone versus Dog Bone button fixation augmented with acromioclavicular repair—a finite element analysis study.Eur J Orthop Surg Traumatol. 2018; 28: 1095-1101
- Persistent disability associated with ankle sprains: a prospective examination of an athletic population.Foot Ankle Int. 1998; 19: 653-660
- Ankle diastasis without fracture.Foot Ankle. 1984; 4: 305-312
- Correlating MRI findings with disability in syndesmotic sprains of NFL players.Foot Ankle Int. 2012; 33: 371-378
- Acute ligamentous diastasis of the ankle without fracture. Evaluation by radionuclide imaging.Am J Sports Med. 1986; 14: 407-409
- Functional outcome after operative treatment for ankle fractures in young athletes: a retrospective case series.Foot Ankle Int. 2008; 29: 887-894
- Diagnostic accuracy of radiologic methods for ankle syndesmosis injury: a systematic review and meta-analysis.J Clin Med. 2019; 8: 968
- Malleolar fractures.AO Principles of Fracture Management. Thieme, New York2000: 559-581
- Fractures of the lower extremity.(editor)in: Canale ST Campbell's Operative Orthopaedics. 39 ed. Mosby, St. Louis, MO1998: 2046-2048
- The management of acute distal tibio-fibular syndesmotic injuries: results of a nationwide survey.Injury. 2012; 43: 1718-1723
- Syndesmotic screw placement: a biomechanical analysis.Foot Ankle Int. 1997; 18: 262-266
- Biomechanical evaluation of syndesmotic screw position: a finite-element analysis.J Orthop Trauma. 2014; 28: 210-215
- Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation.Injury. 2005; 36: 60-64
- The influence of the number of cortices of screw purchase and ankle position in Weber C ankle fracture fixation.J Orthop Trauma. 2008; 22: 473-478
- Syndesmosis fixation using dual 3.5 mm and 4.5 mm screws with tricortical and quadricortical purchase: a biomechanical study.Foot Ankle Int. 2013; 34: 734-739
- Assessment of loads in the knee joint.Med Biol Eng Comput. 1981; 19: 237-243
- The tibiofibular syndesmosis. Evaluation of the ligamentous structures, methods of fixation, and radiographic assessment.J Bone Joint Surg Am. 1995; 77: 847-856
- Suture-endobutton fixation of ankle tibio-fibular diastasis: a cadaver study.Foot Ankle Int. 2003; 24: 142-146
- Comparison of a novel FiberWire-button construct versus metallic screw fixation in a syndesmotic injury model.Foot Ankle Int. 2008; 29: 49-54
- Three-dimensional analysis of fibular motion after fixation of syndesmotic injuries with a screw or suture-button construct.Foot Ankle Int. 2016; 37: 1350-1356
- Hybrid fixation restores tibiofibular kinematics for early weightbearing after syndesmotic injury.Orthop J Sports Med. 2020; 82325967120946744https://doi.org/10.1177/2325967120946744
- Hybrid fixation for Danis-Weber type C fractures with syndesmosis injury.Foot Ankle Int. 2021; 42: 137-144
Article info
Publication history
Published online: May 18, 2022
Footnotes
Financial Disclosure: The authors received no financial support for the research, authorship, and/or publication of this article.
Conflict of Interest: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for both authors are available online.
Place or institution where the work was developed, city and country: Medical Faculty of Selcuk University, Konya, Turkey.
This statement is to certify that all authors have seen and approved the manuscript being submitted. We warrant that the article is the authors' original work. We warrant that the article has not received prior publication and is not under consideration for publication elsewhere. On behalf of all co-authors, the corresponding author shall bear full responsibility for the submission. We granted that; we do not have any conflict of interest.
Identification
Copyright
© 2022 by the American College of Foot and Ankle Surgeons. All rights reserved.
