Walking on a tightrope: Our experience in the treatment of traumatic ankle syndesmosis rupture

Abstract

O63] Should calcaneal fractures be treated operatively or nonoperatively?Introduction: The management of calcaneal fractures is an issue of debate. Management involves operative and nonoperative treatment for displaced intra-articular calcaneal fractures (DIACF). The aim of this review was to decide which method of management is more effective.Methods: A systematic review was performed to assess the available evidence.Search: Cochrane and Medline databases--limited to meta-analyses; randomized clinical (RCT) and multi-centre trials involving humans in English language.The studies from October 1998 until present date were included (since the last systematic review in Cochrane database).Results: The search revealed 23 papers, of which 6 papers were eligible and critically analyzed to assess the level of evidence. There were four randomized clinical trials, one meta-analysis and one multi-centre case-control study.The four RCTs revealed that there was no overall difference in outcomes (p = 0.001) between the groups. Operative results were better in females (RR = 3.18), patients with lighter workloads (RR = 4.04) and if patient not receiving Worker's Compensation (p = 0.01) with fewer complications in these groups. All four studies had limited power to substantiate these conclusions. The meta-analysis included poor studies with no validated outcome measures and the multi-centre trial was poorly designed with unreliable results.Conclusion: There are limitations is all the current available evidence concerning the management of calcaneal fractures. The current evidence suggests that there is no overall difference in outcomes between operative and non-operative management. There may be a benefit for operative treatment for females, young males, patients not making compensation claims and those with less severe fractures with higher Böhler angles with jobs involving a light to moderate workload.

Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair

“…Four abstracts following a scientific meeting, published in well renowned journals, were identified and were found adequately usable [ 18 , 34 , 44 , 60 ].…”

“…In the TightRope group two of these studies showed a higher AOFAS score (ten and six points increase, respectively), whereas one showed a three-point lower outcome on a modified score. A total of seven studies used a (non-modified) AOFAS score in the suture-button treatment group [ 9 , 14 , 34 , 39 , 42 , 59 ]. The weighted average outcome of 133 patients in these six studies was 89.1 points, with an average study follow-up of 19 months.…”

Complications of Suture Button Ankle Syndesmosis Stabilization with Modifications of Surgical Technique

“…There have been three other published cases of infection related to TightRopes requiring removal of the device. 1,4,9 As described in the Arthrex TM TightRope  Surgeon's Guide, the FiberWire is best cut 1 cm beyond the knot. We concur with a recent report suggesting the importance of burying the sharp end of the suture adjacent to the fibula to prevent skin irritation.…”

Tightrope walking: A new technique in ankle syndesmosis fixation

“…Radiographic findings indicative of a failed procedure include a button that is not in contact with the cortex (suggestive of loosening or inadequate tension), widening of the lateral ankle mortise, and soft-tissue masses adjacent to either button. Such soft-tissue masses represent postoperative formation of granulomatous fibrous tissue, likely due to an inflammatory reaction to the buttons ( 10 , 16 ), and may require surgical revision.…”