A systematic review of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury

Zhang, Pei; Liang, Yuan; He, Jing; Fang, Yongchao; Chen, Pengtao; Wang, Jingcheng

doi:10.1186/s12891-017-1645-7

Cited by 119 publications

(143 citation statements)

References 38 publications

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“…A lot of studies investigated the equality of both treatment options with numerous advantages of the suture-button device over the screw xation (28). Zhang et al described in their review that both devices had similar functional outcomes and postoperative complication rates.…”

Section: Discussionmentioning

confidence: 99%

Differences in gait analysis and clinical outcome after TightRope® or screw fixation in acute syndesmosis rupture: Study protocol for a prospective randomized pilot study

Doll

Waizenegger

Brückner

et al. 2020

Preprint

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Abstract Background: Ankle sprains and fractures are most common injuries in orthopedic and trauma surgery. The concurrent occurrence of syndesmosis ruptures in these injuries represents a more complex problem, as they often remain undetected. A proper and accurate treatment of injuries of the syndesmosis, both isolated and combined with fractures, is necessary to avoid long-term consequences (chronic instability, cartilage damage and post-traumatic osteoarthritis). The most popular treatment option is a static screw fixation and the newly developed dynamic TightRope® (Arthrex, Naples, FL, USA). The aim of this pilot study is to compare monitor ankle range of motion and maximum ankle power in gait as functional outcome parameters of instrumented gait analysis, as well as clinical and radiographic outcome for assessing the stabilization of acute syndesmosis rupture with either a static implant (a 3.5mm metallic screw) or a dynamic device (TightRope®).Methods: This prospective, randomized, controlled, clinical trial will be carried out at the Center for Orthopedics, Trauma Surgery and Spinal Cord Injury of the University Hospital Heidelberg. Adult patients, who suffer from an acute syndesmosis rupture, both isolated and in combination with fractures of the lateral malleolus (Weber C and Maisonneuve fractures) and who are undergoing surgery at our trauma center will be included in our study. The patients will be randomized to the different treatment options (screw fixation or “TightRope®”). Subsequent to the surgical treatment, all patients will receive the same standardized follow-up procedures including a gait analysis and MRI of the ankle at 6 months follow-up.The primary endpoint of the study is the successful healing of the syndesmosis and biomechanical investigation with gait analysis.Discussion: The results of the gait analysis from the current study will help to impartially and reliably evaluate the clinical and biomechanical outcome of both treatment options of acute syndesmosis ruptures. We hypothesize that the dynamic fixation provides an equivalent or better biomechanical, clinical and radiographic outcome in comparison to the screw fixation.Trial registration:German Clinical Trials Register (DRKS), ID: DRKS00013562, registered on 07.12.2017.

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Section: Discussionmentioning

confidence: 99%

Differences in gait analysis and clinical outcome after TightRope® or screw fixation in acute syndesmosis rupture: Study protocol for a prospective randomized pilot study

Doll

Waizenegger

Brückner

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…A lot of studies investigated the equality of both treatment options with numerous advantages of the suture-button device over the screw fixation (25). Zhang et al described in their review that both devices had similar functional outcomes and postoperative complication rates.…”

Section: Discussionmentioning

confidence: 99%

Differences in gait analysis and clinical outcome after TightRope® or screw fixation in acute syndesmosis rupture: Study protocol for a prospective randomized trial

Doll¹,

Waizenegger²,

Brückner³

et al. 2020

Preprint

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Abstract Background: Ankle sprains and fractures are most common injuries in orthopedic and trauma surgery. The concurrent occurrence of syndesmosis ruptures in these injuries represents a more complex problem, as they often remain undetected. A proper and accurate treatment of injuries of the syndesmosis, both isolated and combined with fractures, is necessary to avoid long-term consequences (chronic instability, cartilage damage and post-traumatic osteoarthritis). The most popular treatment option is a static screw fixation and the newly developed dynamic TightRope® (Arthrex, Naples, FL, USA). The aim of this study is to compare monitor ankle range of motion and maximum ankle power in gait as functional outcome parameters of instrumented gait analysis, as well as clinical and radiographic outcome for assessing the stabilization of acute syndesmosis rupture with either a static implant (a 3.5mm metallic screw) or a dynamic device (TightRope®). Methods: This prospective, randomized, controlled, clinical trial will be carried out at the Center for Orthopedics, Trauma Surgery and Spinal Cord Injury of the University Hospital Heidelberg. Adult patients, who suffer from an acute syndesmosis rupture, both isolated and in combination with fractures of the lateral malleolus (Weber C and Maisonneuve fractures) and who are undergoing surgery at our trauma center will be included in our study. The patients will be randomized to the different treatment options (screw fixation or “TightRope®”). Subsequent to the surgical treatment, all patients will receive the same standardized follow-up procedures including a gait analysis and MRI of the ankle at 6 months follow-up. The primary endpoint of the study is the successful healing of the syndesmosis and biomechanical investigation with gait analysis. Discussion: The results of the gait analysis from the current study will help to impartially and reliably evaluate the clinical and biomechanical outcome of both treatment options of acute syndesmosis ruptures. We hypothesize that the dynamic fixation provides an equivalent or better biomechanical, clinical and radiographic outcome in comparison to the screw fixation.

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“…Generally, it has not been shown to offer superior results compared with ‘conventional’ screw fixation. 42 , 43 Certainly, it should not be used where there is vertical instability, such as when a syndesmotic injury is associated with a multifragmented high Weber C-type/PER fibula fracture. 44 …”

Section: Treatmentmentioning

confidence: 99%

Stability in ankle fractures

2018

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Medial column (deltoid ligament) integrity is of key importance when considering the stability of isolated lateral malleolus ankle fractures.Weight-bearing radiographs are the best method of evaluating stability of isolated distal fibula fractures.Computed tomography (CT) scanning is mandatory for the assessment of complex ankle fractures, especially those involving the posterior malleolus.Most isolated trans-syndesmotic fibular fractures (Weber-B, SER, AO 44-B) are stable and can safely be treated non-operatively.Posterior malleolus fractures, regardless of size, should be considered for surgical fixation to restore stability, reduce the need for syndesmosis fixation, and improve contact pressure distribution.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170057

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A systematic review of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury

Cited by 119 publications

References 38 publications

Differences in gait analysis and clinical outcome after TightRope® or screw fixation in acute syndesmosis rupture: Study protocol for a prospective randomized pilot study

Differences in gait analysis and clinical outcome after TightRope® or screw fixation in acute syndesmosis rupture: Study protocol for a prospective randomized pilot study

Differences in gait analysis and clinical outcome after TightRope® or screw fixation in acute syndesmosis rupture: Study protocol for a prospective randomized trial

Stability in ankle fractures

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