title: Evaluation of Reduction Accuracy of Suture-Button and Screw Fixation Techniques for Syndesmotic Injuries.
abstract: BACKGROUND
  Among the most important predictors of functional results of treatment of syndesmotic injuries is the accurate restoration of the syndesmotic space. The purpose of this study was to investigate the reduction performance of screw fixation and suture-button techniques using images obtained from computed tomography (CT) scans.
  
  
  METHODS
  Patients at or below 65 years who were treated with screw or suture-button fixation for syndesmotic injuries accompanying ankle fractures between January 2012 and March 2015 were retrospectively reviewed in our regional trauma unit. A total of 52 patients were included in the present study. Fixation was performed with syndesmotic screws in 26 patients and suture-button fixation in 26 patients. The patients were divided into 2 groups according to the fixation methods. Postoperative CT scans were used for radiologic evaluation. Four parameters (anteroposterior reduction, rotational reduction, the cross-sectional syndesmotic area, and the distal tibiofibular volumes) were taken into consideration for the radiologic assessment. Functional evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale at the final follow-up. The mean follow-up period was 16.7 ± 11.0 months, and the mean age was 44.1 ± 13.2.
  
  
  RESULTS
  There was a statistically significant decrease in the degree of fibular rotation (P = .03) and an increase in the upper syndesmotic area (P = .006) compared with the contralateral limb in the screw fixation group. In the suture-button fixation group, there was a statistically significant increase in the lower syndesmotic area (P = .02) and distal tibiofibular volumes (P = .04) compared with the contralateral limbs. The mean AOFAS scores were 88.4 ± 9.2 and 86.1 ± 14.0 in the suture-button fixation and screw fixation group, respectively. There was no statistically significant difference in the functional ankle joint scores between the groups.
  
  
  CONCLUSIONS
  Although the functional outcomes were similar, the restoration of the fibular rotation in the treatment of syndesmotic injuries by screw fixation was troublesome and the volume of the distal tibiofibular space increased with the suture-button fixation technique.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Ankara Education and Research Hospital, Orthopedics and Traumatology Department, Ankara, Turkey onurkocadal@gmail.com.
authors.forename: Onur
authors.initials: O
authors.lastname: Kocadal
authors.affiliation: Department of Orthopedics and Traumatology, Dr. Nafiz Korez Sincan State Hospital, Ankara, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yucel
authors.affiliation: Ankara Education and Research Hospital, Orthopedics and Traumatology Department, Ankara, Turkey.
authors.forename: Murad
authors.initials: M
authors.lastname: Pepe
authors.affiliation: Department of Orthopedics and Traumatology, Medical Park Hospital, Ankara, Turkey.
authors.forename: Ertugrul
authors.initials: E
authors.lastname: Aksahin
authors.affiliation: Ankara Education and Research Hospital, Orthopedics and Traumatology Department, Ankara, Turkey.
authors.forename: Cem Nuri
authors.initials: CN
authors.lastname: Aktekin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D005593:Fracture Fixation, Internal / Q000379:methods; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery; D006801:Humans; D008023:Ligaments, Articular / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: ankle; screw; suture-button; syndesmosis