title: Tightrope fixation of syndesmotic injuries in Weber C ankle fractures: a multicentre case series.
abstract: BACKGROUND
  No general consensus has yet been established for the gold standard treatment of ankle syndesmotic complex injuries. Recent literature has documented the success of ankle tightrope fixation for heterogeneous ankle fracture patterns, resulting in syndesmotic complex injuries. We present a multicentre case series assessing the clinical, radiological and functional outcomes of patients with Weber C ankle fractures treated with the Arthrex TightRope®fixation system.
  
  
  METHODS
  We performed a retrospective analysis of all adult patients with Weber C ankle fractures who were treated with the Arthrex TightRope®fixation system at four centres over a 3-year period. All patients were followed up for a mean of 14 months (range 12-26). Outcomes measures were assessed subjectively using functional scores (AOFAS and Olerud and Molander) and objectively using radiological measurements, complication rates and revision surgery rates.
  
  
  RESULTS
  Thirty-six patients met our eligibility criteria. The mean age at operation was 31 years (range 18-65). There were 20 males and 16 females. No patients were lost to follow-up. The ankle tightrope maintained satisfactory reduction in the ankle mortise in 97% of cases. Of these 35 successfully treated cases, no evidence of re-displacement on follow-up radiographs of the syndesmotic complex was observed at an average of 10.8 months (range 6-12). Post-operative mean medial clear space was 3.1 mm, and mean tibio-fibular overlap was 10.1 mm. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 88.8 (range 67-98) at a mean follow-up of 14 months (range 12-26). The overall complication rate was 6% (one failure requiring revision surgery and one medial sided skin irritation requiring removal of suture button). No infections or wound complications occurred.
  
  
  CONCLUSIONS
  Tightrope fixation is a safe alternative to screw fixation for syndesmotic complex injuries in Weber C ankle fractures. We have shown that it has low complication rates and a high patient satisfaction.
authors.affiliation: Imperial College London Hospitals, London, UK.
authors.forename: Amarjit
authors.initials: A
authors.lastname: Anand
authors.affiliation: Croydon University Hospital, 530 London Road, Surrey, CR7 7YE, UK.
authors.forename: Ran
authors.initials: R
authors.lastname: Wei
authors.affiliation: Imperial College London Hospitals, London, UK.
authors.forename: Akash
authors.initials: A
authors.lastname: Patel
authors.affiliation: Hillingdon and Mount Vernon Hospital, London, UK.
authors.forename: Vikas
authors.initials: V
authors.lastname: Vedi
authors.affiliation: Northwick Park Hospital, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Garth
authors.initials: G
authors.lastname: Allardice
authors.affiliation: Croydon University Hospital, 530 London Road, Surrey, CR7 7YE, UK. bobby.anand2@nhs.net.|The Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, UK. bobby.anand2@nhs.net.
authors.forename: Bobby Singh
authors.initials: BS
authors.lastname: Anand
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D001860:Bone Plates; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods / Q000534:rehabilitation; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D007593:Joint Instability / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D016683:Supine Position; D016896:Treatment Outcome; D055815:Young Adult
keywords: Ankle; Diastasis; Fractures; Suture button; Syndesmosis; Syndesmosis reconstruction; Syndesmosis reduction; Syndesmosis repair; Syndesmotic complex; Tightrope; Weber C