title: Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes.
abstract: Syndesmosis screws have significant problems including loosening, breakage, the need for removal, and late diastasis. A new technique of syndesmosis fixation is proposed in this study, in which a heavy suture is placed across the syndesmosis, which has been looped and tightened through cortical button anchors on either side of the ankle. Indirect placement of the medial button avoids a medial incision. Sixteen patients had this suture-button fixation in a prospective clinical study. Mean American Orthopaedic Foot and Ankle Society ankle scores were significantly better in patients who had suture-button fixation than in a comparative group of 16 patients who had syndesmosis screw fixation at 3 months (91 versus 80, respectively) and at 12 months postoperatively (93 versus 83, respectively). Return to work was faster (2.8 months in patients who had suture-button fixation versus 4.6 months who had syndesmosis screw fixation), and no patients who had suture-buttons required secondary surgery for implant removal. Axial computed tomography scanning at 3 months showed maintenance of reduction. Suture-button fixation is simple, safe, and effective. Patients have had improved outcomes and faster rehabilitation, without needing routine implant removal. It may become the treatment of choice in patients with a syndesmosis injury.
authors.affiliation: Department of Orthopaedics, Limerick Regional Hospital, Limerick, Ireland. brianthornes@esatclear.ie
authors.forename: Brian
authors.initials: B
authors.lastname: Thornes
authors.forename: Fintan
authors.initials: F
authors.lastname: Shannon
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Guiney
authors.forename: Paul
authors.initials: P
authors.lastname: Hession
authors.forename: Eric
authors.initials: E
authors.lastname: Masterson
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D013537:Sutures; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome