title: Suture-endobutton fixation of ankle tibio-fibular diastasis: a cadaver study.
abstract: Suture-Endobutton fixation is proposed as a minimally invasive, flexible fixation of ankle tibio-fibular diastasis, which would not require routine removal. This study tested the Suture-Endobutton construct in a cadaver syndesmosis injury model and compared this against A.O. syndesmosis screw fixation. Sixteen embalmed cadaver legs were used. Phase one consisted of placing the leg in a jig, generating an external rotation torque and measuring diastasis with increasing intraosseous membrane division. Phase two then compared the Suture-Endobutton construct vs. single four-cortex 4.5 mm A.O. screw fixation. Diastasis increased significantly with increasing intraosseous membrane division (p<0.001). No significant differences were seen in the mean rate of failure between the Suture-Endobutton and A.O. screw fixation. However, the Suture-Endobutton did give a significantly more consistent performance; the distribution of standard deviations for A.O. screw fixation was 0.64 mm higher than that for the Endobutton (95% C.I. 0.46 to 0.84). These results show that Suture-Endobutton fixation at least equals the performance of screw fixation and encourages clinical trials in ankle injuries with a syndesmosis diastasis.
authors.affiliation: Department of Orthopaedic Surgery, Department of Anatomy, Beaumont Hospital, Dublin 9, Trinity College Dublin, Ireland. brianthornes@esatclear.ie
authors.forename: Brian
authors.initials: B
authors.lastname: Thornes
authors.forename: Alan
authors.initials: A
authors.lastname: Walsh
authors.forename: Matt
authors.initials: M
authors.lastname: Hislop
authors.forename: Paraic
authors.initials: P
authors.lastname: Murray
authors.forename: Moira
authors.initials: M
authors.lastname: O'Brien
mesh_terms: D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D001863:Bone Screws; D002102:Cadaver; D005360:Fibula / Q000601:surgery; D006801:Humans; D016268:Internal Fixators; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D011897:Random Allocation; D012399:Rotation; D012421:Rupture; D013536:Suture Techniques; D013977:Tibia / Q000601:surgery