title: Maintenance of reduction with suture button fixation devices for ankle syndesmosis repair.
abstract: BACKGROUND
  Malreduction of the syndesmosis can lead to increased peak pressures and subsequent arthritis. The purpose of this study was to evaluate the initial syndesmotic reduction and radiographic maintenance when using a knotless suture button fixation device for treatment of syndesmotic injury.
  
  
  METHODS
  A retrospective chart and radiographic review was performed to identify patients who underwent open reduction internal fixation of ankle syndesmosis ruptures treated with a knotless, suture button fixation system. Radiographic measurements included medial clear space, tibiofibular overlap, tibiofibular clear space, and the distance between buttons. Fifty-six patients underwent repair of an ankle fracture with syndesmotic rupture over a 3-year period, with a mean follow-up of 160.9 days.
  
  
  RESULTS
  The tibiofibular clear space and tibiofibular overlap significantly improved from pre- to first postoperative, but also demonstrated some loss of fixation at final follow-up (P < .001). The distance between the buttons increased on average 1.1 mm from immediate postoperative to final follow-up, demonstrating some postoperative creep and loss of fixation in the system. A low complication rate and need for a revision operation was found in our patient cohort. Some loss of reduction did occur postoperatively, although this did not correlate to adverse patient outcomes.
  
  
  CONCLUSIONS
  Syndesmotic stabilization, using a knotless suture button fixation device demonstrated adequate initial syndesmotic reduction, but also exhibited an increase in the tibiofibular clear space and tibiofibular overlap, relative to initial postfixation position, at short-term follow-up.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Suburban Orthopaedics, Bartlett, IL, USA ofacresearch@orthofootankle.com.
authors.forename: Kyle S
authors.initials: KS
authors.lastname: Peterson
authors.affiliation: Harvard Foot and Ankle, Hollywood, FL, USA.
authors.forename: W Drew
authors.initials: WD
authors.lastname: Chapman
authors.affiliation: Orthopedic Foot and Ankle Center, Westerville, OH, USA.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Hyer
authors.affiliation: Orthopedic Foot and Ankle Center, Westerville, OH, USA.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Berlet
mesh_terms: D000328:Adult; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D008297:Male; D009984:Orthopedic Fixation Devices; D011859:Radiography; D012189:Retrospective Studies
keywords: ZipTight™; ankle; suture button; syndesmosis