title: A modified technique for fixation of chronic instability of the distal tibiofibular syndesmosis using a wire and button.
abstract: Distal tibiofibular syndesmosis injury accounts for 1% to 11% of soft tissue injuries of the ankle. Some acute syndesmotic injuries will fail to heal effectively owing to inadequate treatment or misdiagnosis, eventually resulting in chronic instability, which can destroy the stability of the ankle joint. Various surgical techniques have been described for fixation of the syndesmosis. Among the existing methods, the suture button has the advantage of allowing for physiologic micromotion at the syndesmosis by maintaining the reduction and preventing the risk of screw breakage. However, the "relatively" long suture between buttons can gradually relax under continuous loading, resulting in fixation failure, which we have termed electric wire phenomenon. In the present report, we have described a modified technique for flexible fixation using the Endobutton CL ULTRA fixation device by tricortical fixation, instead of quadricortical fixation, to allow for robust and reliable fixation of the distal tibiofibular syndesmosis. The modified technique is devoid of the concern regarding the use of screw fixation and can reduce the risk of displacement or elongation and skin irritation associated with the suture button.
authors.affiliation: Department of Orthopedics, Shenyang Military Region General Hospital, Shenyang, Liaoning Province, People's Republic of China.
authors.forename: Bing
authors.initials: B
authors.lastname: Xie
authors.affiliation: Department of Orthopedics, Shenyang Military Region General Hospital, Shenyang, Liaoning Province, People's Republic of China.
authors.forename: Yan-feng
authors.initials: YF
authors.lastname: Jing
authors.affiliation: Department of Orthopedics, Shenyang Military Region General Hospital, Shenyang, Liaoning Province, People's Republic of China.
authors.forename: Liang-bi
authors.initials: LB
authors.lastname: Xiang
authors.affiliation: Department of Orthopedics, Shenyang Military Region General Hospital, Shenyang, Liaoning Province, People's Republic of China.
authors.forename: Da-peng
authors.initials: DP
authors.lastname: Zhou
authors.affiliation: Department of Orthopedics, Shenyang Military Region General Hospital, Shenyang, Liaoning Province, People's Republic of China. Electronic address: bone@medmail.com.cn.
authors.forename: Jing
authors.initials: J
authors.lastname: Tian
mesh_terms: D016512:Ankle Injuries / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D001864:Bone Wires; D002908:Chronic Disease; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D053441:Suture Anchors
keywords: ankle; chronic injury; ligament; surgical treatment; syndesmosis