A 24-Month Follow-Up of a Custom-Made Suture-Button Assembly for Syndesmotic Injuries of the Ankle

• Published in: The Journal of foot and ankle surgery Vol. 56; no. 4; pp. 744 - 747
• Main Authors: Imam, Mohamed A., MD, PhD, FRCS(Tr & Orth), Matthana, Ahmed, MD, PhD, Kim, Ji Wan, MD, PhD, Nabil, Mohamed, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017; by the American College of Foot and Ankle Surgeons
• Subjects: Adolescent; Adult; Aged; ankle; Ankle Fractures - diagnostic imaging; Ankle Fractures - etiology; Ankle Fractures - surgery; diastasis; Female; Follow-Up Studies; Fracture Fixation, Internal - instrumentation; Humans; Internal Fixators; Male; Middle Aged; Orthopedics; suture-button fixation; Sutures; talus; tibiofibular syndesmosis; Treatment Outcome; Young Adult; diastasis; suture-button fixation; tibiofibular syndesmosis; 4; ankle; talus
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2017.02.010

Abstract In the present retrospective analysis, we introduce a custom suture-button fixation device for acute ankle syndesmotic injuries that allows for early weightbearing without another planned operation for hardware removal. We evaluated 87 consecutive ankles in 87 patients (49 males [56.32%] and 38 females [43.68%]). Of the 87 patients, 15 (17.24%) withdrew or were lost to follow-up, leaving 72 patients (82.76%) in the present study. Their mean age was 35.2 (range 17 to 67) years. Nineteen patients (26.39%) presented with a pure syndesmotic disruption, and 53 (73.61%) had associated malleolar fractures. The American Orthopaedic Foot and Ankle Society scale score improved significantly from 31.2 ± 4.2 preoperatively to 88.5 ± 5.3 at an average of 24 months postoperatively ( p  < .0043). Revision was undertaken because of implant failure in 4 ankles (5.56%). Two revisions (2.78%) were performed in 2 ankles because of early weightbearing in the first 2 weeks after surgery. The third patient (1.39%) underwent revision at 5 weeks postoperatively. This syndesmotic reduction failure was attributed to failure of the threads, which was noted at the second surgery. The fourth patient (1.39%), a 66-year-old male, underwent revision at 5 months postoperatively because of persistent infection. An 18-month postoperative radiograph was available for all patients. The medial clear space had significantly decreased, from 8.2 ± 3.1 mm preoperatively to 3.5 ± 2.2 mm at 18 months postoperatively ( p  < .0344). Likewise, the tibiofibular clear space had decreased significantly, from a mean of 8.8 ± 3.7 mm preoperatively to a mean of 3.7 ± 2.2 mm at 18 months postoperatively ( p < .0322). In conclusion, suture-button fixation described in the present report delivered satisfactory functional outcomes and anatomic reduction at minimum of 18 months after surgery.