Suture Button Fixation for Syndesmosis Injuries: Review of the Literature

Abstract

Syndesmosis injuries -also known as high ankle sprains-have an increasing popularity because of an increased awareness of diagnosis. Different from lateral ankle sprains, mechanism of injury mostly involves external rotation, eversion and excessive dorsiflexion. Other mechanisms can also cause sydesmosis injuries. Because of high levels of missed injuries the real prevalence of syndesmosis injuries is underestimated. It is less frequently seen than lateral ankle injuries. For diagnosis, physical and radiological examination is essential.In radiological examination, associated injuries must be determined if present. Mostly seen associated injury is ankle fracture. Nonoperative treatment provides good results for syndesmosis injuries. Surgical treatment is indicated when syndesmosis injuries include frank diastasis. Arthroscopic view of syndesmotic instability is another indication. Failed conservative treatment may also be an indication. There are a lot of options for surgical fixation. Screws are the most popular among others but there are some complications about them. Alternatively, suture button fixation technique can be used. Suture button fixation is an implant with two metallic buttons surrounded with thick fiberwire sutures. Its stabilization mechanism depends on compression of two buttons to opposite sites by the help of fiberwire. It is designed to resist diastasis but allows small movement to other planes. It is very suitable for fixation of syndesmosis injuries and also to have less complication rates. Purpose of this study is to discuss the syndesmotic injuries and review the suture button fixation technique for the treatment.

Caso Clínico: Fractura de Tobillo Weber B, Tratamiento Quirúrgico con Doble Sistema Tightrope®

“…En un estudio conducido por Thornes y colaboradores en comparación con la fijación mediante tornillo (93 versus 83), se obtuvo un mejor resultado al año de seguimiento y un regreso más rápido al trabajo (2.8 meses frente a 4.6 meses); sin embargo, el 75 % de los pacientes con fijación de tornillo necesitó remoción de los dispositivos de fijación mientras que ninguno de los pacientes que fue tratado con TightRope® requirió una segunda cirugía [2]. Coetzee y colaboradores realizaron un estudio prospectivo que comparó el uso de TightRope® y tratamiento con tornillos en el cual se reportó un mejor rango de movimiento, menor rigidez y disconfort en respecto de la primera técnica [16].…”

“…También hay menor necesidad de realizar una segunda cirugía para la extracción del implante, pronto retorno a la actividad física y alta satisfacción del paciente [16,19,20].…”

Evaluating success rate and comparing complications of operative techniques used to treat chronic syndesmosis injuries

“…Its stabilization relies on compression of the two buttons on opposite sides of the syndesmosis provided by the FiberWire suture. 26 The fixation is accomplished by drilling through all four cortices in the transmalleolar axis, pulling the needle, with its Fi-berWire and oblong button, from the lateral to the medial side. Once the oblong button emerges, the surgeon flips it parallel to the bone surface and exerts lateral tension to hold it flush.…”

Tratamento da lesão da sindesmose tibiofibular distal associada às fraturas do tornozelo com suture button

“…A sindesmose tibiofibular distal (STFD) tem como principal estabilizador seu complexo ligamentar, composto pelos ligamentos tibiofibular anterior inferior, tibiofibular posterior inferior, interósseo e transverso. [1][2][3] Embora seja uma das articulações mais estáveis do corpo humano, a STFD apresenta certo grau de mobilidade, como rotação externa, encurtamento relativo da fíbula e pequena abertura durante a carga e movimentos fisiológicos. 3,4 Aproximadamente 80% das lesões ligamentares da STFD estão associadas às fraturas do tornozelo, de modo que o diagnóstico correto e o tratamento adequado destas lesões são de extrema importância para prevenir complicações como edema e dor crônicos, relacionados a sinovite, lesões da cartilagem articular e doença degenerativa secundária à instabilidade crônica desta articulação.…”

“…The distal tibiofibular syndesmosis (DTFS) has, as main stabilizer, its ligament complex, composed of the lower anterior tibiofibular ligaments, the inferior posterior tibiofibular ligaments, the interosseous, and transverse ligaments. [1][2][3] Although it is one of the most stable joints of the human body, the DTFS presents a certain degree of mobility, such as external rotation, relative shortening of the fibula and small opening during load, and physiological movements. 3,4 Approximately 80% of the DTFS ligament injuries are associated with ankle fractures, so that the correct diagnosis and proper treatment of these lesions are extremely important to prevent complications such as chronic edema and pain related to synovitis, joint cartilage injuries, and degenerative disease secondary to chronic instability of this joint.…”