Flexible fixation of syndesmotic diastasis using the assembled bolt-tightrope system

Abstract

BackgroundSyndesmotic diastasis is a common injury. Syndesmotic bolt and tightrope are two of the commonly used methods for the fixation of syndesmotic diastasis. Syndesmotic bolt can be used to reduce and maintain the syndesmosis. However, it cannot permit the normal range of motion of distal tibiofibular joint, especially the rotation of the fibula. Tightrope technique can be used to provide flexible fixation of the syndesmosis. However, it lacks the ability of reducing the syndesmotic diastasis. To combine the advantages of both syndemostic bolt and tightrope techniques and simultaneously avoid the potential disadvantages of both techniques, we designed the assembled bolt-tightrope system (ABTS). The purpose of this study was to evaluate the primary effectiveness of ABTS in treating syndesmotic diastasis.MethodsFrom October 2010 to June 2011, patients with syndesmotic diastasis met the inclusion criteria were enrolled into this study and treated with ABTS. Patients were followed up at 2, 6 weeks and 6, 12 months after operation. The functional outcomes were assessed according to the American Orthopedic Foot and Ankle Society (AOFAS) scores at 12 months follow-up. Patients’ satisfaction was evaluated based upon short form-12 (SF-12) health survey questionnaire. The anteroposterior radiographs of the injured ankles were taken, and the medial clear space (MCS), tibiofibular overlap (TFOL), and tibiofibular clear space (TFCS) were measured. All hardwares were routinely removed at 12-month postoperatively. Follow-ups continued. The functional and radiographic assessments were done again at the latest follow-up.ResultsTwelve patients were enrolled into this study, including 8 males and 4 females with a mean age of 39.5 years (range, 26 to 56 years). All patients also sustained ankle fractures. At 12 months follow-up, the mean AOFAS score was 95.4 (range, 85 to 100), and all patients were satisfied with the functional recoveries. The radiographic MCS, TFOL, and TFCS were within the normal range in all patients. After hardware removal, follow-up continued. At the latest follow-up (28 months on average, (range, 25 to 33 months) from internal fixation), the mean AOFAS score was 96.3 (range, 85 to 100), without significant difference with those assessed at 12 months after fixation operations. No syndesmotic diastasis reoccurred based upon the latest radiographic assessment.ConclusionsABTS can be used to reduce the syndesmotic diastasis and provide flexible fixation in a minimally invasive fashion. It seems to be an effective alternative technique to treat syndesmotic diastasis.

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

“…More recently, the suture-button fixation device has aroused the attention of many orthopedists, especially TightRope. This device has been reported with some potential advantages, such as allowing of physiological movement while retaining the required reduction, less risk of implant removal and recurrent syndesmotic diastasis, and earlier rehabilitation [ 8 – 10 ]. Anatomic reduction has been shown to be the most important predictor of clinical outcomes [ 11 ].…”

Innovations in Orthopedics and Traumatology in China

“…Clinical applications revealed that ABTS could reduce the syndesmotic diastasis and provide flexible fixation in a bionic fashion followed with satisfactory functional recovery of the lower extremities. [ 8 ] Orthopedic surgeons have also created many other novel bionic designs. However, some of these designs have been hindered from the clinical application due to the limited manufacturing capability of complex internal implants.…”

Arthroscopic Syndesmotic Repair

“…Several repair techniques for syndesmotic injury of the ankle are available, including 1- and 2-screw techniques; stainless, titanium, and bioabsorbable screw techniques; modified syndesmotic bolt repair; suture button repair; and assembled bolt-suture button system repair. 1,2,13,14,18-21 However, there is no “gold standard” technique, and the optimal method of syndesmotic fixation remains a topic of debate. All of the above-listed techniques have advantages and disadvantages: for example, in the stainless and titanium screw fixation techniques, late syndesmotic widening following screw removal, and screw loosening, screw breakage, the need for a second operation to remove the screw, and morbidity associated with prolonged immobilization, are all possible outcomes.…”