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Atilla HA, Akdoğan M, Öztürk A, Hayat M, Barça F, Demir EB, Çakar A, Ünal M, Köse Ö. Risk factors associated with breakage of tibio-fibular syndesmotic screws. INTERNATIONAL ORTHOPAEDICS 2024; 48:2201-2209. [PMID: 38771534 DOI: 10.1007/s00264-024-06217-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE This retrospective study aimed to investigate the factors associated with the breakage of tibio-fibular syndesmotic screws (SS). METHODS 69 patients with unstable AO-Weber Type 44-B ankle fractures who underwent three cortex SS (3.5 mm ø) fixation were included. Patients were followed for at least one year (mean, 18.3 ± 7.6 months). At the final follow-up, patients with broken (Group I) and intact (Group II) SS were compared regarding age, gender, height, weight, body mass index, fracture type, SS length, location, and orientation. Multivariate logistic regression was used to identify the independent risk factors associated with SS breakage. The sensitivity, specificity, cut-off value, and area under the ROC curve were analyzed. RESULTS A stepwise backward logistic regression analysis revealed that age was the only independent predictor for SS breakage (OR = 0.938, 95% CI = 0.904-0.973, R2 = 0.270). ROC curve analysis demonstrated that patients younger than 36 years were associated with seven times increased risk of SS breakage [Odds ratio (95% CI), 7.042 (2.251-22.031)]. CONCLUSION Age under 36 years was the only significant risk factor for SS breakage. The higher incidence of breakage of the syndesmotic screw can be informed to patients younger than 36.
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Affiliation(s)
- Halis Atıl Atilla
- Department of Orthopedics and Traumatology, Ankara Etlik City Hospital, Ankara, Turkey.
- Ankara Etlik Şehir Hastanesi, Varlık Mah. Halil Sezai Erkut Cd. Yenimahalle, 06170, Ankara, Turkey.
| | - Mutlu Akdoğan
- Department of Orthopedics and Traumatology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Alper Öztürk
- Department of Orthopedics and Traumatology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Muhammet Hayat
- Department of Orthopedics and Traumatology, Tokat Turhal State Hospital, Tokat, Turkey
| | - Fatih Barça
- Department of Orthopedics and Traumatology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Ekin Barış Demir
- Department of Orthopedics and Traumatology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Albert Çakar
- Department of Orthopedics and Traumatology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Melih Ünal
- Department of Orthopedics and Traumatology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
| | - Özkan Köse
- Department of Orthopedics and Traumatology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey
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Murphy SC, Murphy B, O'Loughlin P. Syndesmotic injury with ankle fracture: A systematic review of screw vs dynamic fixation. Ir J Med Sci 2024; 193:1323-1330. [PMID: 38282112 DOI: 10.1007/s11845-024-03619-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
Cortical screw fixation across the tibiofibular joint is the mainstay of treatment for syndesmotic injury. Dynamic fixation devices have been developed offering similar advantages to screw fixation in terms of reduction and stability of the syndesmosis. Dynamic fixation may also facilitate a more physiological movement between the tibiofibular joint and thus incur less morbidity. Patient's rehabilitation potential is enhanced and reduces the need for hardware removal. Our systematic review aims to analyse the relevant current literature and compare screw fixation to dynamic fixation in the treatment of syndesmotic injury associated with acute ankle fractures. A literature search was performed on Pubmed and Ovid Medline to find scientific papers relating to syndesmotic fixation in acute ankle fractures. Papers were screened and included dependent on predetermined criteria. Risk of bias was assessed after screening full papers by two independent reviewers. Tables and analysis were made using Microsoft excel. A total of 8 papers with 673 patients were included. We found no functional difference between screw fixation or dynamic fixation groups at final follow-up. Three papers showed statistically significant lower rates of reoperation in the dynamic fixation group. Dynamic fixation may offer lower post operative complications and reoperation rates. Therefore, dynamic fixation may be a beneficial alternative treatment compared to traditionally used syndesmotic screws.
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Affiliation(s)
| | - Ben Murphy
- Department of Trauma and Orthopaedic Sugery, Cork University Hospital, Cork, Ireland
| | - Padhraig O'Loughlin
- Department of Trauma and Orthopaedic Sugery, Cork University Hospital, Cork, Ireland
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Jlidi M, Bouaicha W, Sbaihi S, Gharbi H, Lamouchi M, Mallek K, Jaziri S, Daas S. Comparative Study for Surgical Treatment of Acute Distal Tibiofibular Syndesmotic Lesions Using the Modified Suture-Button Fixation Versus Static Syndesmotic Screw Fixation. Foot Ankle Spec 2024:19386400241256440. [PMID: 38814001 DOI: 10.1177/19386400241256440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Several techniques to treat acute distal tibiofibular instability are described consisting in static and dynamic fixation procedures. The aim of our work is to compare the outcomes of acute syndesmotic injury fixation between the modified technique of dynamic fixation using the suture-button principle as an efficient and low-cost method and the classic static fixation. METHODS It is a prospective study including patients presenting with acute syndesmotic injury. After fracture fixation, residual syndesmotic instability was managed using syndesmotic screw in group A and dynamic fixation with a double Ethibond suture in group B. Functional results were assessed using the American Orthopaedic Foot and Ankle Society score (AOFAS) score. Radiological evaluation was done by a postoperative computed tomography (CT) scan of both ankles and plain X-rays of the ankle after surgery and at 18 months. RESULTS Group A included 20 patients meanwhile 35 patients were in group B. The reduction was satisfactory in the 2 groups according to the postoperative CT scan measurements. The mean healing time in group A was 49.65 days and 51.49 days in group B (P = .45). We did not find any significant difference in terms of loss of reduction in the 2 groups. The return to work was faster in group B (P = .04). Patients in group B had better AOFAS score (P = .03) and ankle range of motion than those in group A. The difference was statistically significant (P = .02 for dorsal flexion and P = .001 for plantar flexion). For group A, we did not note any early complications. Meanwhile, 7 patients developed skin complications in group B (P = .03). However, no significant difference was found in terms of late complications. CONCLUSIONS The modified dynamic suture-button fixation remains a therapeutic alternative in low-income countries that could achieve better outcomes than static fixation, with easy postoperative follow-up. LEVELS OF EVIDENCE Level II.
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Affiliation(s)
- Mohamed Jlidi
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Walid Bouaicha
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Siwar Sbaihi
- Department of Radiology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hedi Gharbi
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
| | - Mouldi Lamouchi
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Karim Mallek
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
| | - Salma Jaziri
- Department of Anaesthesia and Intensive Care, Mohamed Bourguiba Hospital, Kef, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Selim Daas
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Voight ML, Norman C, Wilk KE, Lucas M, Wolfe C. Management of High Ankle Sprains Utilizing the Tightrope Surgical Procedure - A Novel Approach for a Rapid Return to Play. Int J Sports Phys Ther 2024; 19:513-521. [PMID: 38707856 PMCID: PMC11065778 DOI: 10.26603/001c.116862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
The distal tibiofibular joint is described as a syndesmosis. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Syndesmotic or high ankle sprains, involving the syndesmotic ligaments, pose a significant rehabilitative challenge due to their intricate anatomy, prolonged recovery periods following injury, and high susceptibility to persistent disability. Traditional management strategies have often been conservative, marked by lengthy periods of immobilization and a gradual return to activity. Severe syndesmotic injuries with diastasis have been treated surgically with screw fixation which may require a second intervention to remove the hardware and carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope™, has gained popularity in treating ankle syndesmosis injuries. The TightRope™ involves inserting Fiberwire® through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. The accelerated rehabilitation protocol promotes early weight-bearing and has been shown to expedite the return to sport. This emerging strategy has shown promise in reducing recovery time as it is now possible to return to sport in less than 2 months after a tightrope repair and accelerated rehabilitation, compared with 3-6 months post screw fixation. This clinical commentary delves into this novel approach, highlighting the procedure, rehabilitation protocols, and the implications for physical therapy practice. Level of Evidence V.
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Bouaicha W, Jlidi M, Sbaihi S, Gharbi MH, Mallek K, Jaziri S, Daas S. A Modified Dynamic Fixation Technique for Acute Syndesmotic Injuries. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241232979. [PMID: 38426008 PMCID: PMC10903226 DOI: 10.1177/24730114241232979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- Walid Bouaicha
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Jlidi
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Siwar Sbaihi
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Radiology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
| | - Mohamed Hedi Gharbi
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
| | - Karim Mallek
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
| | - Salma Jaziri
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Anaesthesia and Intensive Care, Mohamed Bourguiba Hospital, Kef, Tunisia
| | - Selim Daas
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Lim CM, Choi SW, Kim BS, Lee SJ, Kang HS. Dynamic Fixation versus Static Screw Fixation for Syndesmosis Injuries in Pronation External Rotation Ankle Fractures: A Retrospective Case Control Study. Malays Orthop J 2023; 17:48-58. [PMID: 38107359 PMCID: PMC10723001 DOI: 10.5704/moj.2311.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 12/02/2022] [Indexed: 12/19/2023] Open
Abstract
Introduction The current standard treatment for ankle syndesmosis injury is static screw fixation. Dynamic fixation was developed to restore the dynamic function of the syndesmosis. The purpose of this study was to determine that which of static screw fixation and dynamic fixation is better for treatment of ankle syndesmosis injury in pronation-external rotation fractures. Materials and methods Thirty patients were treated with dynamic fixation (DF group) and 28 patients with static screw fixation (SF group). The primary outcome was Olerud-Molander Ankle Outcome Score. The secondary outcome were Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score, radiographic outcomes, complications and cost effectiveness. To evaluate the radiographic outcome, the tibiofibular clear space, tibiofibular overlap, and medial clear space were compared using the pre-operative and last follow-up plain radiographs. To evaluate the cost effectiveness, the total hospital cost was compared between the two groups. Results There was no significant difference in primary outcome. Moreover, there were no significant difference in secondary outcome including Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score and radiographic outcome. Two cases of reduction loss and four cases of screw breakage were observed in the SF group. No complication in the DF group was observed. Dynamic fixation was more cost effective than static screw fixation with respect to the total hospital cost. Conclusion Although dynamic fixation provided similar clinical and radiologic outcome, dynamic fixation is more cost effective with fewer complications than static screw fixation in ankle syndesmosis injury of pronation-external rotation fractures.
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Affiliation(s)
- C M Lim
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - S W Choi
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - B S Kim
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - S J Lee
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
| | - H S Kang
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, South Korea
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Hong CC, Harrison WD, Clough T, Calder J. Association of Periprosthetic Fibula Fracture With Knotless Suture Button (TightRope) Fixation for Ankle Syndesmosis in Elite Athletes. Orthop J Sports Med 2023; 11:23259671231206185. [PMID: 37927967 PMCID: PMC10625313 DOI: 10.1177/23259671231206185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/22/2023] [Indexed: 11/07/2023] Open
Abstract
Background Suture button fixation is frequently used to stabilize the distal tibiofibular syndesmosis in athletes sustaining an isolated ligamentous syndesmosis injury. Purpose To report on a series of periprosthetic fibula fractures adjacent to the lateral suture button after a subsequent unrelated ankle injury or progressive stress injury after initial ankle syndesmosis stabilization using the knotless TightRope (Arthrex). Study Design Case series; Level of evidence, 4. Methods Eight elite athletes with periprosthetic fibula fractures and stress injuries around the lateral suture buttons were evaluated. In all athletes, the knotless TightRope had been used to stabilize an isolated ligamentous ankle syndesmotic injury, after which all patients recovered and returned to professional sports at their preinjury level. The athletes subsequently developed an acute fibula fracture or a fibula stress fracture related to the 3.7-mm drill hole in the fibula adjacent to the lateral suture buttons after a mean of 14.1 months (range, 5-29 months). The management of these complications was analyzed. Results Five athletes sustained a periprosthetic fibula fracture in the form of undisplaced spiral Weber B injuries after a subsequent, unrelated injury. Poor healing response was noted with initial nonoperative treatment for the first 2 athletes, and surgical intervention was performed with successful union of the fracture and return to sports. The subsequent 3 athletes had early surgery with uneventful recovery. Another 3 athletes developed stress injuries adjacent to the fibula suture button without a history of acute trauma. In 2 of the 3 athletes, the position of lateral suture buttons was in the anterior third of the fibula. Initial nonoperative management yielded poor healing response, and subsequent surgical intervention was required to enable healing and return to sports. Conclusion Nonoperative management of fractures adjacent to the fibula suture button of a knotless TightRope may lead to a delay in union. Therefore, early surgical intervention should be considered in elite athletes, whose return-to-sports time is critical. Care is needed to ensure that the fibula hole for the suture button is centrally located because the eccentric placement of the fibula hole in the anterior third of the fibula may contribute to the development of a stress reaction or stress fracture. Surgical intervention for a periprosthetic fibula stress fracture leads to satisfactory resolution of symptoms.
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Affiliation(s)
- Choon Chiet Hong
- Fortius Clinic (FIFA Medical Centre of Excellence), London, UK
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Tim Clough
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - James Calder
- Fortius Clinic (FIFA Medical Centre of Excellence), London, UK
- Department of Bioengineering, Imperial College London, London, UK
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Wixted CM, Luo EJ, Stauffer TP, Wu KA, Adams SB, Anastasio AT. Biomechanical profile of varying suture button constructs in cadaveric specimens: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:344. [PMID: 37675292 PMCID: PMC10477643 DOI: 10.21037/atm-23-1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/21/2023] [Indexed: 09/08/2023]
Abstract
Background Suture button fixation of syndesmotic injuries allows for more physiologic motion of the ankle joint while maintaining adequate reduction and may avoid the need for additional surgeries, given the lower risk of syndesmotic diastasis and implant failure. Few studies have examined the optimal number and configuration of suture buttons for syndesmotic disruption. The purpose of this systematic review and meta-analysis is to compare different suture button configurations from the cadaveric literature and to assess their relative effect on the stability of the syndesmotic reduction and functional movement of the ankle. Methods A literature search in the databases MEDLINE via PubMed, Embase via Elsevier, Scopus via Elsevier, and SPORTDiscus via EBSCO were searched through December 2022 to identify studies related to cadaveric modeling of the syndesmosis. Only cadaveric studies with suture button fixation and studies in English were included. The quality of cadaveric studies was assessed using the Quality Assessment for Cadaveric Studies (QUACS) tool. Revman 5.3 software was used to perform the meta-analysis. Results The meta-analysis included 5 studies and 86 limbs. The systematic review included 15 studies. When comparing single and double suture button configurations, no difference was found between groups with regard to fibular rotation (MD =-0.9; 95% CI: -2.09 to 0.27; I2=79%; P=0.13) and both groups had similar rotational stability. The double suture button technique did demonstrate less sagittal fibular translation compared to the single suture button (MD =0.48; 95% CI: 0.02-0.94; I2=66%; P=0.04). When comparing two suture buttons in parallel and divergent configurations, studies did not find any differences with regard to strength or stability. Conclusions There were no significant differences in biomechanical parameters when comparing single and double suture button constructs. While single button suture constructs result in minimal fibular rotation, double suture button constructs minimize fibular translation. This review may serve as a guide for clinicians when approaching these injuries.
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Affiliation(s)
| | - Emily J. Luo
- Duke University School of Medicine, Durham, NC, USA
| | | | - Kevin A. Wu
- Duke University School of Medicine, Durham, NC, USA
| | - Samuel B. Adams
- Duke University Hospital, Department of Orthopaedics, Durham, NC, USA
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薛 阳, 赵 永, 邓 明, 付 炳, 尹 刚, 刘 颖, 孙 广. [TightRope elastic fixation combined with functional total repair of inferior tibiofibular ligament in treatment of distal tibiofibular syndesmosis injury]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:964-969. [PMID: 37586796 PMCID: PMC10435333 DOI: 10.7507/1002-1892.202305020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/14/2023] [Indexed: 08/18/2023]
Abstract
Objective To study the effectiveness of TightRope elastic fixation combined with functional total repair of the inferior tibiofibular ligament in the treatment of distal tibiofibular syndesmosis injury. Methods The clinical data of 34 patients with distal tibiofibular syndesmosis injury who met the selection criteria between January 2020 and January 2022 were retrospectively analyzed, and they were divided into improved group (TightRope elastic fixation combined with functional total repair of inferior tibiofibular ligament) and control group (distal tibiofibular screw fixation) according to the surgical methods, with 17 cases in each group. There was no significant difference in age, gender, body mass index, fracture type, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, and complications were recorded in the two groups. The American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle metatarsal flexion and dorsal extension range of motion were used to evaluate the ankle function. The patient satisfaction survey was conducted at last follow-up. Results All 34 patients were followed up 8-20 months, with a median of 13 months. The operation time and intraoperative blood loss in the improved group were significantly longer than that in the control group (P<0.05). In the improved group, no infection or poor reduction occurred, and only 1 patient had TightRope knot reaction at 6 months after operation. In the control group, there were 2 cases of poor reduction, 1 case of lower tibiofibular screw rupture, and 1 case of subcutaneous infection (cured after anti-infection treatment). There was no significant difference in the incidence of complications between the two groups (P>0.05). At last follow-up, the AOFAS score and ankle metatarsal flexion and dorsal extension range of motion of the improved group were significantly better than those of the control group (P<0.05). The satisfaction rates of patients in the improved group and the control group were 94.1% and 82.4%, respectively, showing significant difference (P<0.05). Conclusion TightRope elastic fixation combined with functional total repair of inferior tibiofibular ligament in the treatment of distal tibiofibular syndesmosis injury has sufficient fixation strength, and can achieve better effectiveness and joint function compared with traditional screw fixation.
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Affiliation(s)
- 阳 薛
- 滨州医学院附属医院足踝外科(山东滨州 256603)Department of Foot and Ankle Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
| | - 永杰 赵
- 滨州医学院附属医院足踝外科(山东滨州 256603)Department of Foot and Ankle Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
| | - 明明 邓
- 滨州医学院附属医院足踝外科(山东滨州 256603)Department of Foot and Ankle Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
| | - 炳金 付
- 滨州医学院附属医院足踝外科(山东滨州 256603)Department of Foot and Ankle Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
| | - 刚 尹
- 滨州医学院附属医院足踝外科(山东滨州 256603)Department of Foot and Ankle Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
| | - 颖 刘
- 滨州医学院附属医院足踝外科(山东滨州 256603)Department of Foot and Ankle Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
| | - 广超 孙
- 滨州医学院附属医院足踝外科(山东滨州 256603)Department of Foot and Ankle Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
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Barbachan Mansur NS, Godoy-Santos AL, Schepers T. High-Ankle Sprain and Syndesmotic Instability: How Far Have We Come with Diagnosis and Treatment? Foot Ankle Clin 2023; 28:369-403. [PMID: 37137630 DOI: 10.1016/j.fcl.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Probably one of the most controversial subjects in the orthopedic field is the distal tibiofibular articulation. Even though its most primary knowledge can be a matter of enormous debate, it is in the diagnosis and treatment most of the disagreements reign. Distinguishing between injury and instability remains challenging as well as an optimal clinical decision regarding surgical intervention. The last years presented technology and that was able to bring body to an already well-developed scientifical rationale. In this review article, we aim to demonstrate the current data behind syndesmotic instability in the ligament scenario, whereas using few fracture concepts.
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Affiliation(s)
- Nacime Salomao Barbachan Mansur
- Escola Paulista de Medicina - Universidade Federal de São Paulo, Brazil; University of Iowa, Carver College of Medicine, USA.
| | | | - Tim Schepers
- Trauma Unit, Department of Surgery, Amsterdam UMC Location J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Pavone V, Papotto G, Vescio A, Longo G, D’Amato S, Ganci M, Marchese E, Testa G. Short and Middle Functional Outcome in the Static vs. Dynamic Fixation of Syndesmotic Injuries in Ankle Fractures: A Retrospective Case Series Study. J Clin Med 2023; 12:3637. [DOI: https:/doi.org/10.3390/jcm12113637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Abstract
Background: Syndesmotic injuries are common lesions associated with ankle fractures. Static and dynamic fixation are frequently used in syndesmotic injury-associated ankle fractures. The purpose of this study is to compare short- and mid-term quality of life, clinical outcomes, and gait after static stabilization with a trans-syndesmotic screw or dynamic stabilization with a suture button device. Methods: Here, 230 patients were enrolled in a retrospective observational study. They were divided in two groups according to the fixation procedure (Arthrex TightRope®, Munich, Germany) synthesis vs. osteosynthesis with a 3.5 mm trans-syndesmotic tricortical screw). They then underwent clinical assessment using the American Foot and Ankle Score (AOFAS) at 1, 2, 6, 12, and 24 months after surgery. Quality of life was assessed according to the EuroQol-5 Dimension (EQ-5D) at 2 and 24 months after surgery in the follow-up; gait analysis was performed 2 and 24 months postoperatively. Results: Significant differences were found at a two-month follow-up according to the AOFAS (p = 0.0001) and EQ-5D (p = 0.0208) scores. No differences were noted in the other follow-ups (p > 0.05) or gait analysis. Conclusion: The dynamic and static fixation of syndesmotic injuries in ankle fracture are both efficacious and valid procedures for avoiding ankle instability. The suture button device was comparable to the screw fixation according to functional outcomes and gait analysis.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95123 Catania, Italy
| | - Giacomo Papotto
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95123 Catania, Italy
| | - Gianfranco Longo
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Salvatore D’Amato
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95123 Catania, Italy
| | - Marco Ganci
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Emanuele Marchese
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95123 Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico—San Marco, University of Catania, 95123 Catania, Italy
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12
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Pavone V, Papotto G, Vescio A, Longo G, D'Amato S, Ganci M, Marchese E, Testa G. Short and Middle Functional Outcome in the Static vs. Dynamic Fixation of Syndesmotic Injuries in Ankle Fractures: A Retrospective Case Series Study. J Clin Med 2023; 12:jcm12113637. [PMID: 37297832 DOI: 10.3390/jcm12113637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Syndesmotic injuries are common lesions associated with ankle fractures. Static and dynamic fixation are frequently used in syndesmotic injury-associated ankle fractures. The purpose of this study is to compare short- and mid-term quality of life, clinical outcomes, and gait after static stabilization with a trans-syndesmotic screw or dynamic stabilization with a suture button device. METHODS Here, 230 patients were enrolled in a retrospective observational study. They were divided in two groups according to the fixation procedure (Arthrex TightRope®, Munich, Germany) synthesis vs. osteosynthesis with a 3.5 mm trans-syndesmotic tricortical screw). They then underwent clinical assessment using the American Foot and Ankle Score (AOFAS) at 1, 2, 6, 12, and 24 months after surgery. Quality of life was assessed according to the EuroQol-5 Dimension (EQ-5D) at 2 and 24 months after surgery in the follow-up; gait analysis was performed 2 and 24 months postoperatively. RESULTS Significant differences were found at a two-month follow-up according to the AOFAS (p = 0.0001) and EQ-5D (p = 0.0208) scores. No differences were noted in the other follow-ups (p > 0.05) or gait analysis. CONCLUSION The dynamic and static fixation of syndesmotic injuries in ankle fracture are both efficacious and valid procedures for avoiding ankle instability. The suture button device was comparable to the screw fixation according to functional outcomes and gait analysis.
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Affiliation(s)
- Vito Pavone
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Giacomo Papotto
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Gianfranco Longo
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Salvatore D'Amato
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Marco Ganci
- Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy
| | - Emanuele Marchese
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical-Surgical Specialties, Section of Orthopaedics and Traumatology, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
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13
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Zhong Q, Zhan J, Yang H, Zhu N, Feng R, Yao Y. A New Method of Nice Knot Elastic Fixation for Distal Tibiofibular Syndesmosis Injury. Orthop Surg 2023; 15:785-792. [PMID: 36710316 PMCID: PMC9977588 DOI: 10.1111/os.13635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The distal tibiofibular syndesmosis (DTS) is a fretting joint and it is still a hot issue how to satisfy strong internal fixation while allowing fretting. This study described and evaluated a new method for elastic fixation of DTS injury with Nice Knot. METHODS The study was designed as a retrospective study. Between June 2020 and June 2021, 31 patients who were diagnosed with ankle fracture and DTS injury without additional orthopedic injuries were enrolled in this case series. The study included 22 males and nine females, with an average age of 34.71 ± 14.66 years. All patients were treated with Nice Knot binding for DTS. Surgical time, length of stay, time of DTS fixation, total weight-bearing time, complications, imaging parameters, and functional scores at follow-up were recorded. Paired sample t-tests or single factor analyses of variance were used at intra-group comparison. RESULTS All patients completed surgery with normal syndesmotic parameters. The recovery of DTS injury was verified by Hook and lateral malleolus rotation tests. The average follow-up time was 15.97 ± 3.30 months. Only one case showed superficial infection after surgery, and the wound healed after symptomatic treatment. In terms of imaging, there were no significant differences in tibiofibular clear space (TFCS), tibiofibular overlap distance (TFOS), medial clear space (MCS), and superior clear space (SCS) immediately and at different follow-up points after surgery. All obtained excellent and good outcomes according to the AOFAS score at least follow-up after surgery. CONCLUSIONS Nice Knot elastic fixation of DTS injury is firm and stable while maintaining the physiological micromotion of the ankle joint.
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Affiliation(s)
- Qigang Zhong
- Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Junfeng Zhan
- Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Hu Yang
- Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Nan Zhu
- Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Ru Feng
- Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Yunfeng Yao
- Second Affiliated Hospital of Anhui Medical UniversityHefeiChina
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14
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Jin-Tao Q, Mei W, Chao-Jun L, Zi-Tian W, Guang P, Hao Y, Yu-Quan J, Yu T. Clinical outcomes of an olive wire and external fixator versus a metallic screw in the treatment of inferior tibiofibular syndesmosis injuries in ankle fractures. Foot Ankle Surg 2023; 29:233-238. [PMID: 36754689 DOI: 10.1016/j.fas.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Metal screws are the most widely used in treating syndesmotic injuries, but failure and the rigidity of the screws can threaten the success of the treatment and increase the cost of care. We have provided an alternative with an olive wire and external fixator(OWEF) used for syndesmotic fixation. METHODS A retrospective longitudinal follow-up study was conducted. From February 2011 to January 2018, 58 of 72 patients with ankle fractures and associated syndesmotic disruption were treated with either screw or OWEF fixation. The costs, complications, and clinical outcomes using Olerud-Molander score and Visual Analog score in screw and OWEF fixation group were compared. RESULTS We found the severity of the injury, BMI of the patients and the different fixation methods were determinants of the complications and clinical outcomes. But if no malreduction of the syndesmosis was present, no difference in clinical result was detected. CONCLUSION The OWEF method appeared to be at least equally functional and effective to screw fixation while maintaining possible lower complication rate. LEVELS OF CLINICAL EVIDENCE Level 3.
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Affiliation(s)
- Qu Jin-Tao
- Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China
| | - Wang Mei
- Department of Anaesthesia, The 925th Hospital, 67# Huanghe RD, China
| | - Li Chao-Jun
- Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China
| | - Wang Zi-Tian
- Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China
| | - Peng Guang
- Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China
| | - Yang Hao
- Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China
| | - Jiang Yu-Quan
- Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China.
| | - Tang Yu
- Department of Orthopedics, Xinqiao Hospital, 400037 Chongqing, China.
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15
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Doyle MD, Ligas CJ, Vora NS. Acute Syndesmosis Injuries. Clin Podiatr Med Surg 2023; 40:23-37. [PMID: 36368846 DOI: 10.1016/j.cpm.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Ankle syndesmosis injuries include isolated ligamentous rupture, as well as fractures with ligamentous injury. These injuries can significantly affect athletes in all sports, and lead to prolonged recovery and return to sport. Adequate evaluation and diagnosis of these injuries are imperative for treatment and return to play. Many can be treated nonoperatively, but operative treatment is indicated in fractures with syndesmosis disruption and ligamentous injuries with instability. Anatomic reduction and fixation of these injuries will allow functional rehab and return to sport.
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Affiliation(s)
- Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, 701 East El Camino Real, Mountain View, CA 94040, USA.
| | - Chandler J Ligas
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, 701 East El Camino Real, Mountain View, CA 94040, USA
| | - Nishit S Vora
- Saint Mary's Medical Center, 450 Stanyan Street, San Francisco, CA 94117, USA
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16
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Presurgical Perspective and Postsurgical Evaluation of Instability and Microinstability Secondary to Ankle Ligaments Injury. Semin Musculoskelet Radiol 2022; 26:644-655. [PMID: 36791734 DOI: 10.1055/s-0042-1760245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Injuries of the ankle ligaments complexes are very common, and ∼ 20 to 40% of patients can develop chronic ankle instability (CAI). Current concepts in CAI allow a better understanding of the ankle biomechanics needed to repair it. The surgical treatment of CAI has evolved in the last decade, and ankle arthroscopy has become an essential tool in the treatment of instability with promising results. We review the different surgical techniques to treat CAI, both those frequently used and the new approaches, as well as the normal postsurgical appearance of ankle ligaments repair and the most common complications.
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17
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Rougereau G, Langlais T, Vigan M, Hardy A, Vialle R, Marty-Diloy T, Cambon-Binder A. Ankle syndesmosis biomechanical evaluation by shear-waves elastography in healthy young adults: Assessment of the reliability and accuracy of the measurements and definition of a corridor of normality. Foot Ankle Surg 2022; 28:1279-1285. [PMID: 35717494 DOI: 10.1016/j.fas.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Aims of this study were: 1/ to evaluate the shear wave speed (SWS) properties of the anteroinferior tibiofibular ligament (AITFL) and the distal interosseous membrane (DIOM) in neutral, dorsal flexion and plantar flexion positions in a cohort of healthy adult volunteers; 2/ to assess the reliability and reproducibility of these measurements. METHODS Both ankles were analyzed by shear wave elastography (SWE) in 20 healthy patients (10 females/10 males) standing on a hinge support with their ankles in neutral, 20° dorsal flexion and 30° plantar flexion positions. Stiffness of AITFL and DIOM was evaluated by SWS measurement. RESULTS The SWS of AITFL and DIOM were minimal in the plantar flexion position (4.28 m/s [2.65-5.11] and 3.35 m/s [1.69-4.55], respectively). It increased significantly for both ligaments in neutral position (4.69 m/s [3.53-5.71] and 3.81 m/s [1.91-4.74], respectively; p < 0.0001), and reached their maximum values in dorsal flexion (6.58 m/s [5.23-8.34] and 4.79 m/s [3.07-6.19], respectively; p < 0.0001). There was no correlation between each ligament regardless the positions. SWS of AITFL was independent of demographic characteristics analyzed. SWS of DIOM was negatively correlated with height in dorsal flexion (ρ = -0.35; p = 0.03) and in plantar flexion (ρ = -0.37; p = 0.02). Female gender was associated with increased DIOM SWS in neutral (p = 0.005), dorsal flexion (p = 0.003), and plantar flexion (p = 0.001) positions. Moreover, foot morphology (foot arch, hind foot frontal deviation) did not impact AITFL nor DIOM SWS. Inter- and intra-observer measurements were all good or excellent. CONCLUSION The AITFL and DIOM, stabilizers of the distal tibiofibular syndesmosis, increase in stiffness while dorsal flexion increases. This study describes a reliable and reproducible protocol to assess their stiffness by SWE, and defines a corridor of normality.
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Affiliation(s)
- Grégoire Rougereau
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Sorbonne University, Department of Adult Orthopedic Surgery, Pitié-Salpêtrière Hospital, APHP, 75571 Paris, France.
| | - Tristan Langlais
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Toulouse University, Department of Pediatric Orthopedic Surgery, Children's Hospital, Purpan, Toulouse, France
| | - Marie Vigan
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; Department of Adult Orthopedic surgery, Hospital Ambroise Paré, APHP, 92100 Boulogne-Billancourt, France
| | - Alexandre Hardy
- Clinique du sport, Department of Orthopedic Surgery, 75005 Paris, France
| | - Raphaël Vialle
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France; The MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris, France
| | - Thibault Marty-Diloy
- Sorbonne University, Department of Pediatric Orthopedic Surgery, Armand Trousseau Hospital, APHP, 75571 Paris, France
| | - Adeline Cambon-Binder
- Sorbonne University, Department of Adult Orthopedic Surgery, Saint Antoine Hospital, APHP, 75571 Paris, France
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18
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Aitor IG, Galvez-Sirvent E, Martinez-Diez JM, Pallares-Sanmartín J, Kalbakdij-Sanchez C, Mills S, Rubio-Suarez JC, Gil-Garay E, Rodriguez-Merchan EC. Comparative CT Study on Syndesmosis Mobility after Static or Dynamic Fixation for Ankle Fractures with Syndesmotic Rupture: A Pilot Study. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:702-711. [PMID: 36258740 PMCID: PMC9569140 DOI: 10.22038/abjs.2022.61845.3020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The objective of this prospective randomized pilot study is to compare, by computed tomography (CT), the mobility of syndesmosis after static fixation (SF) or dynamic fixation (DF) in ankle fractures with syndesmotic rupture (AFSR) in adults, and to compare this mobility with that of healthy ankles. METHODS Forty-two patients with an AFSR were randomized to 2 groups: SF (N=21) or DF (N=21). Seven patients were lost to follow-up. Ultimately, 35 patients (SF, N=20; DF, N=15) were analyzed. The clinical results were assessed with the American Orthopedic Foot and Ankle Society scale. To assess syndesmosis mobility, CT in 30° of plantar flexion (PFlex) and 20° of dorsal flexion (DFlex) was performed on both ankles one year after the fracture. Four parameters were measured: anterior tibiofibular distance, posterior tibiofibular posterior distance, angle of fibular rotation (AFR), and anteroposterior fibular translation. RESULTS The AFR between DFlex and PFlex was more similar to the non-affected side in the DF group. The other three parameters showed no statistical differences between types of fixation. The mean loss of AFR compared with the non-affected side was 1.2° in the SF group and 0.1° in the DF group. No clinical differences between the SF group and the DF group were found. No correlation between clinical and radiological results was observed. CONCLUSION The AFR was more similar to the non-affected side in the DF group. However, this finding did not correlate with a better clinical result.
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Affiliation(s)
- Ibarzabal-Gil Aitor
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain
| | - Elena Galvez-Sirvent
- Department of Orthopedic Surgery, Infanta Elena University Hospital, Valdemoro, Madrid, Spain
| | | | | | | | - Sarah Mills
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain
| | - Juan C. Rubio-Suarez
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain
| | - Enrique Gil-Garay
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain
| | - E. Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research, IdiPAZ (La Paz University Hospital, Autonomous University of Madrid), Madrid, Spain
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19
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Hookway S, Lambers A, Page R, Bedi H. The Australian ankle syndesmosis injury survey. Injury 2022; 53:2304-2310. [PMID: 35219537 DOI: 10.1016/j.injury.2022.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/29/2022] [Accepted: 02/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND & OBJECTIVE The ankle syndesmosis is frequently disrupted in ankle injuries, with higher incidence in concomitant ankle fractures. There is debate regarding the most appropriate surgical management of these injuries, with the development of suture-button devices challenging the conventional approach of surgical stabilisation with syndesmotic screws. The primary aim of this study was to assess current practice variation at a national level, enabling a comparison with reported practice around the world. The secondary aims were to assess practice variation between operative indications and inconsistencies between surgeon device usage and personal preference should they be injured themselves. METHODS A 20-item survey detailing surgical experience, diagnosis, surgical management preference and a series of case studies was conducted. The survey was endorsed and promoted by the Australian Orthopaedic Association (AOA). RESULTS 125 responses were received during the three-month study period. The most commonly used method to stabilise a syndesmotic injury by Australian orthopaedic surgeons was two 3.5 mm screws (26.4%), closely followed by one suture-button (23.2%). Overall, 44% of surgeons employ a dynamic stabilisation method and 54.4% a static stabilisation method. Half of surgeons recommend routine removal of syndesmosis screws, and surgeons tend to use two devices for high Weber C fractures. One third of surgeons who most commonly use screws in their practice would actually prefer a suture-button for management of their own syndesmosis injury. CONCLUSION Significant variability remains in the management of syndesmosis injuries. This survey of Australian orthopaedic surgeons reveals higher suture-button device use when compared to other countries.
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Affiliation(s)
- Sam Hookway
- Barwon Health, Geelong, Victoria, Australia.
| | | | - Richard Page
- Barwon Health, Geelong, Victoria, Australia; St John of God Hospital, Geelong, Victoria, Australia; Barwon Centre for Orthopaedic Research and Education, IMPACT, School of Medicine, Deakin University, Geelong, Victoria, Australia
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20
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Application of an arched, Ni-Ti shape-memory connector in repairing distal tibiofibular syndesmosis ligament injury. BMC Musculoskelet Disord 2022; 23:476. [PMID: 35590289 PMCID: PMC9118800 DOI: 10.1186/s12891-022-05449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the clinical effect of internal fixation of a Ni–Ti arched shape-memory connector in the treatment of distal tibiofibular syndesmosis ligament injury. Methods From January 2013 to January 2016, 108 cases of ankle fracture with distal tibiofibular syndesmosis ligament injury in our hospital were selected, and all of them were fixed with ASCs or screw fixation. The functional evaluation and efficacy evaluation were performed according to the Olerud Molander Ankle Score (Omas) and SF-36. At the same time, follow-ups recorded the incidence of postoperative complications: osteoarthritis, superficial infection, symptomatic hard and soft tissue irritation, early removal and poor reduction of internal fixation, and later loss of reduction. Results In the ASC(Ni–Ti Arched shape-memory Connector) group, the incidence of symptomatic hardware, soft tissue or superficial infection decreased to 2.77%(from 13.8% or 11.1% in SCREW group). The early removal rate(2.77%) of internal fixation was also lower than that of the screw group. While the incidence of osteoarthritis is 13.8% in SCREW group, the incidence of osteoarthritis in the later follow-up was also as low as 1.38% in ASC group. Loss of fracture reduction due to removal of the fixation device for the distal tibiofibular syndesmosis ligament was not observed in the ASC group. With two postoperative scoring systems (OMAS and SF-36), patients in the ASC group significantly get higher score than that in SCREW group. Conclusion The design of the Ni–Ti arched shape-memory connector can be adapted to the irregular anatomical structure of the malleolus and the ability to continue to contract by body temperature. The use of ASCs in fixation of articular ligaments can preserve a slight range of motion, and the results suggest that ASCs can effectively reduce the incidence of fixation looseness, fracture, infection and other complications.
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Gu F, Zhang J, Sui Z, Zhang K, Xie X, Yu T. Minimally Invasive Percutaneous TightRope® System Fixation for an Unstable Posterior Pelvic Ring: Clinical Follow-up and Biomechanical Studies. Orthop Surg 2022; 14:1078-1092. [PMID: 35470582 PMCID: PMC9163799 DOI: 10.1111/os.13261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 12/23/2022] Open
Abstract
Objective To evaluate the mechanical stability and clinical efficacy of minimally invasive percutaneous TightRope® systems applied via gun‐shaped reduction forceps for unstable posterior pelvic ring fractures. Materials and methods This study consists of two parts: a clinical retrospective study and a randomized controlled biomechanical test. For the clinical study, a retrospective analysis of posterior pelvic ring fractures was performed between June 2015 and May 2020. Eighteen patients underwent surgery using two TightRope® systems to fix a broken posterior pelvic ring because of unstable AO type C1 and C2 pelvic ring fractures. The patients were followed up for at least 2 years, and all patients were evaluated using the Majeed scoring system and vertical displacement. In the biomechanical tests, six embalmed adult pelvic specimens were used. The fractures were subjected to TightRope®, IS screw, and TBP fixation in a randomized block design. The specimens were placed in a biomechanical testing machine in a standing neutral posture. A cyclic vertical load of up to 500 N was applied, and the displacement of the specimens was recorded by the testing machine. The ultimate load in each group of specimens was recorded. The displacement and ultimate load were compared and analyzed by statistical methods. Results At a mean follow‐up of 38.89 ± 8.72 months, the functional Majeed score was excellent in 14 patients and good in four patients. The final radiological examinations showed that the outcome was excellent in 14 patients and good in four patients. In these patients, no serious clinical complications were found. Weight‐bearing was delayed in four patients. In biomechanical tests, the displacement of the specimens fixed with TightRope® was significantly lower than that of the specimens fixed with TBP (P < 0.05) when the load ranged from 300 to 500 N. The displacement in the IS screw group was significantly lower than that in either the TBP or TightRope® group (P < 0.05) when the load ranged from 0 to 500 N. The ultimate load in the IS screw group (1798 ± 83.53 N) was significantly greater than that in the TBP group (1352 ± 74.41 N) (t = 9.78, P < 0.0001) and the TightRope® group (1347 ± 54.28 N) (t = 11.11, P < 0.0001). However, no significant difference was observed between the TightRope® and TBP groups (t = 0.13, P = 0.90). Conclusion Percutaneous posterior TightRope® system shows strong stability in mechanical experiments and shows good results in clinical follow‐up while this system has certain advantages in lower surgical requirements and lower risk of related nerve and vascular structural damage.
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Affiliation(s)
- Feng Gu
- Department of Orthopaedics, First Hospital of Jilin University, Changchun, China
| | - Jiting Zhang
- Department of Orthopaedics, First Hospital of Jilin University, Changchun, China
| | - Zhenjiang Sui
- Department of Orthopaedics, First Hospital of Jilin University, Changchun, China
| | - Ke Zhang
- Department of Orthopaedics, First Hospital of Jilin University, Changchun, China
| | - Xiaoping Xie
- Department of Orthopaedics, First Hospital of Jilin University, Changchun, China
| | - Tiecheng Yu
- Department of Orthopaedics, First Hospital of Jilin University, Changchun, China
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Chan LYT, Heng HYC, Kon Kam King C. Investigating the Radiological Outcomes of Syndesmosis Injuries in Ankle Fracture Patients After Suture Button Fixation. J Foot Ankle Surg 2022; 61:350-354. [PMID: 34657805 DOI: 10.1053/j.jfas.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
Concomitant syndesmotic injury occurs in 10% of ankle fractures. Anatomic reduction and maintenance of this reduction is critical in ensuring ankle stability and preventing long-term complications. This is a retrospective cohort study aimed at evaluating the mid-term radiological outcomes of syndesmotic injuries in ankle fracture patients after surgical fixation with suture button device. The study group included 33 patients. Plain radiographs including anteroposterior, lateral and mortise views of the affected ankle were performed preoperatively, postoperatively and at 3-month follow-up. Anteroposterior views were used to measure the amount of tibiofibular overlap and tibiofibular clear space. Paired Student's t test and linear model regression were performed. Between the immediate postoperative and 3-month follow-up period, there was a mean decrease in tibiofibular overlap of 0.841 (±2.07) mm (p = .0259). There was a mean increase in tibiofibular clear space of 0.621 (±1.46) mm (p = .0201). In addition, we found significant correlation between fracture type and change in tibiofibular clear space (p = .047). Our study showed that there is statistically significant widening of the syndesmosis after suture button fixation at 3-month follow-up as evidenced by reduced tibiofibular overlap and increase in tibiofibular clear space. However, they remain within the maximum threshold for acceptable syndesmotic widening of 1.5 mm. Further correlation between radiological outcomes and patient function is needed to determine clinical significance of these changes.
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Affiliation(s)
- Li Yi Tammy Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | | | - Charles Kon Kam King
- Department of Orthopaedic Surgery, Changi General Hospital, Singapore, Singapore
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Böhler C, Benca E, Hirtler L, Kolarik F, Zalaudek M, Mayr W, Windhager R. A biomechanical in-vitro study on an alternative fixation technique of the pubic symphysis for open book injuries of the pelvis. Injury 2022; 53:339-345. [PMID: 34895919 DOI: 10.1016/j.injury.2021.11.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/14/2021] [Accepted: 11/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Implant failure rates remain high after plate fixation in pelvic ring injuries. The aim of this study was to compare an alternative fixation technique with suture-button devices and anterior plate fixation in partially stable open-book injuries. MATERIAL AND METHODS We acquired 16 human fresh frozen anatomic pelvic specimens. The sacrospinous, sacrotuberous, and anterior sacroiliac ligaments were bilaterally released, and the pubic symphysis transected to simulate a partially stable open-book (AO/OTA 61-B3.1) injury. The specimens were randomly assigned to the two fixation groups. In the first group two suture-button devices were placed in a criss-crossed position through the symphysis. In second group a six-hole plate with standard 3.5 unlocked bicortical screws was used for fixation. Biomechanical testing was performed on a servo-hydraulic apparatus simulating bilateral stance, as described by Hearn and Varga. Cyclic compression loading with a progressively increasing peak load (0.5 N/cycle) was applied until failure. The failure mode, the load and the number of cycles at failure and the proximal and distal distance of the symphysis during testing were compared. RESULTS There was no implant failure in either of the two groups. Failures occurred in nine pelvises (56.2%) at the fixation between the sacrum and the mounting jig and in seven pelvises (43.8%) in the sacroiliac joint. Neither the ultimate load nor the number of cycles at failure differed between the surgical techniques (p = 0.772; p = 0.788, respectively). In the suture button group the mean ultimate load was 874.5 N and the number of cycles at failure was 1907.9. In the plate group values were 826.1 N and 1805.6 cycles, respectively. No significant differences at proximal and distal diastasis of the symphysis were monitored during the whole loading process. CONCLUSION The fixation with suture button implants showed comparable results to anterior plate fixation in open-book injuries of the pelvis.
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Affiliation(s)
- Christoph Böhler
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
| | - Emir Benca
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Lena Hirtler
- Division of Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Florian Kolarik
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Zalaudek
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Winfried Mayr
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
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Hunt KJ, Bartolomei J, Challa SC, McCormick JJ, D'Hooghe P, Tuffiash M, Amendola A. Significant variations in surgical construct and return to sport protocols with syndesmotic injuries: an ISAKOS global perspective. J ISAKOS 2022; 7:13-18. [DOI: 10.1016/j.jisako.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lehtola R, Leskelä HV, Flinkkilä TE, Pakarinen HJ, Niinimäki JL, Ohtonen PP, Kortekangas TH. Syndesmosis fixation in supination-external rotation ankle fractures. Long-Term results of a prospective randomised study. Foot Ankle Surg 2022; 28:229-234. [PMID: 33832816 DOI: 10.1016/j.fas.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/11/2021] [Accepted: 03/19/2021] [Indexed: 02/04/2023]
Abstract
BACKROUND The clinical relevance and treatment of syndesmosis injury in supination-external rotation (SER) ankle fractures are controversial. METHODS After malleolar fixation 24 SER 4 ankle fracture patients with unstable syndesmosis in external rotation stress test were randomised to syndesmosis transfixation with a screw (13 patients) or no fixation (11 patients). Mean follow-up time was 9.7 years (range, 8.9-11.0). The primary outcome measure was the Olerud-Molander Ankle Outcome Score (OMAS). Secondary outcome measures included ankle mortise congruity and degenerative osteoarthritis, 100-mm visual analogue scale for function and pain, RAND 36-Item Health Survey, and range of motion. RESULTS Mean OMAS in the syndesmosis transfixation group was 87.3 (SD 15.5) and in the no-syndesmosis-fixation group 89.0 (SD 16.0) (difference between means 1.8, 95% CI -10.4-14.0, P = 0.76). There were no differences between the two groups in secondary outcome measures. CONCLUSION With the numbers available, SER 4 ankle fractures with unstable syndesmosis can be treated with malleolar fixation only, with good to excellent long-term functional outcome.
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Affiliation(s)
- Ristomatti Lehtola
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Kajaanintie 50, P.O. Box 21, FI 90029 OYS Oulu, Finland; Medical Research Center Oulu, University of Oulu, Pentti Kaiteran Katu 1, P.O. Box 8000, FI-90014 Oulu, Finland.
| | - Hannu-Ville Leskelä
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Kajaanintie 50, P.O. Box 21, FI 90029 OYS Oulu, Finland.
| | - Tapio E Flinkkilä
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Kajaanintie 50, P.O. Box 21, FI 90029 OYS Oulu, Finland.
| | - Harri J Pakarinen
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Kajaanintie 50, P.O. Box 21, FI 90029 OYS Oulu, Finland; Pohjola Sairaala, Kiilakivenkuja 1, 90250 Oulu, Finland.
| | - Jaakko L Niinimäki
- Department of Radiology, Oulu University Hospital, Kajaanintie 50, P.O. Box 21, FI 90029 OYS Oulu, Finland.
| | - Pasi P Ohtonen
- Division of Operative Care, Oulu University Hospital, Kajaanintie 50, P.O. Box 21, FI 90029 OYS Oulu, Finland.
| | - Tero H Kortekangas
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Kajaanintie 50, P.O. Box 21, FI 90029 OYS Oulu, Finland.
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Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries. J Clin Med 2022; 11:jcm11020331. [PMID: 35054025 PMCID: PMC8780481 DOI: 10.3390/jcm11020331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Surgical treatment of unstable syndesmotic injuries is not trivial, and there are no generally accepted treatment guidelines. The most common controversies regarding surgical treatment are related to screw fixation versus dynamic fixation, the use of reduction clamps, open versus closed reduction, and the role of the posterior malleolus and of the anterior inferior tibiofibular ligament (AITFL). Our aim was to draw important conclusions from the pertinent literature concerning surgical treatment of unstable syndesmotic injuries, to transform these conclusions into surgical principles supported by the literature, and finally to fuse these principles into an evidence-based surgical treatment algorithm. Methods: PubMed, Embase, Google Scholar, The Cochrane Database of Systematic Reviews, and the reference lists of systematic reviews of relevant studies dealing with the surgical treatment of unstable syndesmotic injuries were searched independently by two reviewers using specific terms and limits. Surgical principles supported by the literature were fused into an evidence-based surgical treatment algorithm. Results: A total of 171 articles were included for further considerations. Among them, 47 articles concerned syndesmotic screw fixation and 41 flexible dynamic fixations of the syndesmosis. Twenty-five studies compared screw fixation with dynamic fixations, and seven out of these comparisons were randomized controlled trials. Nineteen articles addressed the posterior malleolus, 14 the role of the AITFL, and eight the use of reduction clamps. Anatomic reduction is crucial to prevent posttraumatic osteoarthritis. Therefore, flexible dynamic stabilization techniques should be preferred whenever possible. An unstable AITFL should be repaired and augmented, as it represents an important stabilizer of external rotation of the distal fibula. Conclusions: The current literature provides sufficient arguments for the development of an evidence-based surgical treatment algorithm for unstable syndesmotic injuries.
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Marasco D, Russo J, Izzo A, Vallefuoco S, Coppola F, Patel S, Smeraglia F, Balato G, Mariconda M, Bernasconi A. Static versus dynamic fixation of distal tibiofibular syndesmosis: a systematic review of overlapping meta-analyses. Knee Surg Sports Traumatol Arthrosc 2021; 29:3534-3542. [PMID: 34455448 DOI: 10.1007/s00167-021-06721-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Multiple Level I meta-analyses were conducted comparing traditional static vs. more recently introduced dynamic strategies of fixation for injuries of the distal tibiofibular syndesmosis (TFS). The aim of this review was to assess their robustness and methodological quality, providing support in the choice of a treatment strategy in case of TFS injury using the highest level of evidence. METHODS In this systematic review, conducted in accordance with the PRISMA guidelines, meta-analyses/systematic reviews comparing static and dynamic fixation methods after acute TFS injury were identified. The robustness of studies was evaluated using the fragility index (FI) for meta-analysis and the fragility quotient (FQ). The risk of bias was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Finally, the Jadad was applied to select the study which provided the highest quality of evidence to develop recommendations for the fixation strategy of these lesions. RESULTS Out of 1.302 records, four Level I meta-analyses were included in this study. Analyzing the statistically significant dichotomous outcomes, the median FI was 3.5 (IQR, 2 to 5.5; range, 1 to 9), while the median FQ was 1.9% (IQR, 1 to 3.5; range 0.35 to 4.4). In total, 37% had an FI of 2 or less and 75% of outcomes had a FI of 4 or less. According to the AMSTAR score and Jadad algorithm, the largest meta-analysis was selected as the highest evidence provided so far. CONCLUSION The meta-analyses with statistically significant dichotomous outcomes comparing dynamic and static fixation for treating injuries of the distal tibiofibular syndesmosis are fragile, with a change in less than four patients or less than 2% of the study population sufficient to reverse a significant outcome to nonsignificant. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Domenico Marasco
- Department of Public Health, Trauma and Orthopaedics, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Jacopo Russo
- Department of Public Health, Trauma and Orthopaedics, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Antonio Izzo
- Department of Public Health, Trauma and Orthopaedics, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Salvatore Vallefuoco
- Department of Public Health, Trauma and Orthopaedics, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Francesco Coppola
- Department of Public Health, Trauma and Orthopaedics, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Shelain Patel
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Francesco Smeraglia
- Department of Public Health, Trauma and Orthopaedics, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Giovanni Balato
- Department of Public Health, Trauma and Orthopaedics, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Massimo Mariconda
- Department of Public Health, Trauma and Orthopaedics, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Alessio Bernasconi
- Department of Public Health, Trauma and Orthopaedics, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy.
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Elabd A, Abdullah S, Kandel W, Hegazy M. Syndesmotic Stabilization: Syndesmotic Screw Versus Flexible Fixation: A Systematic Review. J Foot Ankle Surg 2021; 60:998-1007. [PMID: 33846031 DOI: 10.1053/j.jfas.2020.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 02/03/2023]
Abstract
Syndesmotic injuries are common injuries that occur in isolation or associated with ankle fractures. The suture button device fixation (SBDF) has become increasingly attractive to orthopedic surgeons as an alternative to metallic screw fixation (MSF) for syndesmotic fixation. This review involved the highest-quality clinical biomechanical and cost analysis studies to provide a comprehensive review. A literature search in the electronic databases was conducted to identify clinical, biomechanical as well as cost analysis studies in which the MSF was compared to SBDF from 1990 to 2018. Only comparative clinical studies with a level of evidence I or II were included besides any comparative biomechanical or cost analysis study. The (PRISMA) guidelines were followed. Eight clinical, 11 biomechanical, and 3 cost analysis studies were included. The clinical studies consisted of 5 randomized controlled trials (RCTs) and 3 cohort studies. The average American Orthopaedic Foot and Ankle Society score for the SBDF group was (92.4) compared to (86.6) for the MSF group at 1 year follow-up. SBDF group showed a lower rate of malreduction, implant removal, implant failure, and complications. The biomechanical studies showed better reduction accuracy in the SBDF group. The reduction maintenance was comparable in the coronal plane but not in the sagittal plane. The cost-effectiveness of the SBDF was highly dependent on the difference in implant removal rate. In conclusion, the SBDF showed comparable to better outcomes compared to the MSF. It may be a better option for syndesmotic fixation.
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Affiliation(s)
- Ahmed Elabd
- Department of Orthopaedic Surgery, Banha School of Medicine, Banha, Egypt.
| | - Samir Abdullah
- Department of Orthopaedic Surgery, Banha School of Medicine, Banha, Egypt
| | - Wael Kandel
- Department of Orthopaedic Surgery, Banha School of Medicine, Banha, Egypt
| | - Mohamed Hegazy
- Department of Orthopaedic Surgery, Banha School of Medicine, Banha, Egypt
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Clinical outcomes of isolated acute instability of the syndesmosis treated with arthroscopy and percutaneous suture-button fixation. Arch Orthop Trauma Surg 2021; 141:1567-1574. [PMID: 33580342 DOI: 10.1007/s00402-021-03813-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/01/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION To present the short- to midterm clinical outcomes of a series of patients with isolated acute syndesmosis instability treated with arthroscopy and percutaneous suture-button fixation. MATERIALS AND METHODS A review of 17 patients treated through the arthroscopic approach. The mean age of the patients was 27.8 years and the mean follow-up was 31.5 months. Clinical and functional evaluations were based on the VAS, AOFAS ankle-hindfoot score and time of return to preinjury level of activities. Imaging analysis was performed with stress radiographs, MRI and CT scan with stress. RESULTS The average VAS was 0.5 and the mean AOFAS score was 95.5. Out of the 17 patients, 15 were able to return to their preinjury level of activities. The mean time of return to activities was 5.06 months. CONCLUSION Arthroscopic approach and percutaneous suture-button fixation provided satisfactory clinical and functional results for selected patients with ASI at short- to midterm follow-up. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Alastuey-López D, Seral B, Pérez MÁ. Biomechanical evaluation of syndesmotic fixation techniques via finite element analysis: Screw vs. suture button. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 208:106272. [PMID: 34293494 DOI: 10.1016/j.cmpb.2021.106272] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Tibiofibular syndesmotic injuries may cause degenerative changes, reduction in ankle function and compromising ankle stability. Different fixation techniques try to restore its functionality. Screw-fixation is the gold-standard. Recently, suture-button fixation has aroused the attention because it allows for physiologic micromotion while maintaining an accurate reduction. The aim of this study is to compare the biomechanical behaviour of both fixation techniques using the finite element method. METHODS A three-dimensional finite element model of the tibiofibular joint was reconstructed simulating the intact ankle and the injured syndesmosis. Then, different methods of syndesmosis fixation were analysed: screws (number of cortices, number of screws and distance between screws) and suture buttons (single, double parallel and double divergent with a sensitivity analysis on the pretension forces) configuration. Ligaments and cartilages were included and simulated as spring elements. Physiological loads during stance phase were simulated. RESULTS Syndesmosis widening and von Mises stresses were computed. Syndesmosis widening in the injured configuration compromised joint stability (2.06 mm), whereas using a single quadricortical screw (0.18 mm) stiffened the joint. Syndesmosis widening using suture-buttons were closer to syndesmosis widening of the intact ankle configuration (0.97 mm). Von Mises stresses were higher for the titanium screws than for the suture buttons. CONCLUSIONS A detailed biomechanical comparison among different syndesmotic fixation was performed. Suture buttons have advantages with regard to syndesmosis widening in comparison to screw fixation. This fact supports the good long-term clinical results obtained with suture buttons fixation. The proposed methodology could be an efficient tool for preoperative planning.
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Affiliation(s)
- Diego Alastuey-López
- M2BE-Multiscale in Mechanical and Biological Engineering, Instituto de Investigación en Ingeniería de Aragón (I3A), Aragón Institute of Health Science (IACS), Universidad de Zaragoza, Campus Río Ebro, c/María de Luna s/n, 50018-Zaragoza, España, Spain.
| | - Belén Seral
- Hospital Universitario "Lozano Blesa", Aragón Institute of Health Science (IACS), University of Zaragoza,, Zaragoza, Spain.
| | - Mª Ángeles Pérez
- M2BE-Multiscale in Mechanical and Biological Engineering, Instituto de Investigación en Ingeniería de Aragón (I3A), Aragón Institute of Health Science (IACS), Universidad de Zaragoza, Campus Río Ebro, c/María de Luna s/n, 50018-Zaragoza, España, Spain.
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Kaftandziev I, Bakota B, Trpeski S, Arsovski O, Spasov M, Cretnik A. The effect of the ankle syndesmosis reduction quality on the short-term functional outcome following ankle fractures. Injury 2021; 52 Suppl 5:S70-S74. [PMID: 33934883 DOI: 10.1016/j.injury.2021.04.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A few radiographic techniques have been proposed to evaluate ankle syndesmosis reduction. The purpose of this study was to analyze post-operatively with CT-scanning the quality of ankle syndesmotic reduction. Moreover, to assess the impact of quality of syndesmotic reduction to functional outcome. MATERIALS AND METHODS A prospective cohort study focused on patients older than 17 years with lateral and medial malleolar fracture with verified syndesmotic disruption. EXCLUSION CRITERIA open fracture, concomitant injury, surgery delayed for more than 24 hours, additional posterior malleolar fracture, ASA score of ≥ 3, complication requiring revision surgery, articular step or gap of ≥ 2mm on the postoperative CT scans. RESULTS Out of 41 patients, 34 participants completed the follow-up. There was a male predominance (20 patients - 58.82%) and the mean age was 48.46±16.1 years (range (20-72 years). 22 patients (64.71%) have sustained type B fracture, while in 12 patients (35.29%) the fracture was of a type C. The reduction was classified as anatomical in 26 patients (76.50%), while in 8 patients (23.50%) the reduction of the syndesmosis was non-anatomical. In those 26 patients in whom the reduction was anatomical, 17 (65.39%) were males and there were 18 (66.67%) type B fractures. In the patients with non-anatomical reduction, 3 patients (37.5%) were of a male gender and there was the equal number of type B and C fractures. The statistical analysis showed significantly favorable scores for both AOFAS score and VAS scale for the patients with anatomical reduction. CONCLUSION Functional analysis showed a strong association with the CT observed reduction quality and both the AOFAS score and VAS scale. Further studies are desirable to provide further evidence in relation to the findings of this study.
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Affiliation(s)
- Igor Kaftandziev
- University Clinic of Traumatology - Medical faculty of Skopje, North Macedonia, Macedonia
| | - Bore Bakota
- Trauma and Orthopaedics Department, Medical University Hospital LKH Graz, Austria
| | - Simon Trpeski
- University Clinic of Traumatology - Medical faculty of Skopje, North Macedonia, Macedonia
| | - Oliver Arsovski
- University Clinic of Traumatology - Medical faculty of Skopje, North Macedonia, Macedonia
| | - Marko Spasov
- University Clinic of Traumatology - Medical faculty of Skopje, North Macedonia, Macedonia.
| | - Andrej Cretnik
- Traumatology Department, University Medical Center Maribor, Slovenia
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The Impact of Suture Button Removal in Syndesmosis Fixation. J Clin Med 2021; 10:jcm10163726. [PMID: 34442022 PMCID: PMC8397003 DOI: 10.3390/jcm10163726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022] Open
Abstract
The suture button (SB) device was introduced to negate the need for routine hardware removal in the treatment of syndesmosis injuries. However, a considerable SB removal rate has been reported, and the impact of removal is unknown. This study aimed to evaluate the radiographic and clinical outcomes after removal of SB for syndesmosis fixation. A total of 36 patients who underwent removal surgery after syndesmosis fixation using SB were identified. The mean postoperative time to removal was 12.2 months. On a plain radiograph, tibiofibular clear space (TFCS) was measured and compared at three follow-up time points. In patients with computed tomography (CT) imaging (n = 18), the anterior-to-posterior (A/P) ratio was measured to evaluate changes in quality of reduction. Additionally, clinical outcomes were assessed. There were no significant differences in TFCS between the three follow-up periods. None of the patients exhibited recurrent diastasis after SB removal. Although CT analysis demonstrated malreduction in six patients (33.3%), five of six patients had a subsequent spontaneous reduction of the syndesmosis. Clinically, all patients described the resolution of symptoms related to painful hardware at the final follow-up. Our results demonstrate that SB removal at one year following syndesmosis fixation leads to improved clinical symptoms without negatively impacting the quality of syndesmosis reduction.
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Lurie BM, Paez CJ, Howitt SR, Pennock AT. Suture-button Versus Screw Fixation in Adolescent Syndesmotic Injuries: Functional Outcomes and Maintenance of Reduction. J Pediatr Orthop 2021; 41:e427-e432. [PMID: 33764338 DOI: 10.1097/bpo.0000000000001803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fixation of the tibiofibular syndesmosis is often performed with a trans-syndesmotic screw (SS) or suture-button (SB). SB fixation has been shown to have lower rates of postoperative syndesmotic malreduction, late diastasis, and implant removal, though some studies have found complications related to infection and implant subsidence. The purpose of this study was to compare maintenance of reduction, complications, implant removal and functional outcomes of SB versus SS fixation in adolescents. METHODS A retrospective chart review identified patients who underwent syndesmotic fixation from 2010 to 2019 at a single institution. Loss of syndesmotic reduction (diastasis) was defined as either a >2 mm increase in tibiofibular clear space or >2 mm decrease in tibiofibular overlap, and corresponding incongruence of the ankle mortise (medial clear space 1 millimeter greater than superior clear space). Functional outcomes were collected at a minimum of 1 year postsurgery using the Foot and Ankle Ability Measure (FAAM). RESULTS Seventy-seven adolescents (45 SS, 32 SB) were included (mean age: 16±1.5 y). Forty-five patients had Weber C fibula fractures, 27 Weber B fractures, and 5 had isolated syndesmotic injuries or small posterior malleolus fractures. Fifty-one patients (66%) had functional outcomes available. There was no significant difference in mean FAAM Sports score between the 2 groups (SB=94.8%, SS=89.8%) at mean follow-up of 4.0±2.1 years. Syndesmotic implant removal occurred in 36/45 patients (80%) in the SS group compared with 4/32 patients (13%) in the SB group. There was 1 case of syndesmotic malreduction requiring revision surgery in the SS group, and no cases of postoperative malreduction or diastasis in the SB group. Nine patients in the SB group and 8 in the SS group weighed over 100 kilograms, with no cases of diastasis in these larger patients. There were 4 superficial infections and 1 deep infection in the screw group, with 1 superficial infection in the SB group. CONCLUSIONS While both SB and screw fixation maintained syndesmotic reduction, SB fixation led to lower rates of implant removal surgery. SB fixation was equally effective at preventing recurrent diastasis in adolescents weighing over 100 kilograms, and functional outcomes were at least equivalent to screw-fixation at mean follow-up of 4.0 years. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Benjamin M Lurie
- Department of Orthopaedic Surgery, University of Nevada, Las Vegas, Las Vegas, NV
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Pogliacomi F, De Filippo M, Casalini D, Longhi A, Tacci F, Perotta R, Pagnini F, Tocco S, Ceccarelli F. Acute syndesmotic injuries in ankle fractures: From diagnosis to treatment and current concepts. World J Orthop 2021; 12:270-291. [PMID: 34055585 PMCID: PMC8152437 DOI: 10.5312/wjo.v12.i5.270] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/14/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023] Open
Abstract
A stable and precise articulation of the distal tibiofibular syndesmosis maintains the tibiofibular relationship, and it is essential for normal motion of the ankle joint. The disruption of this joint is frequently accompanied by rotational ankle fracture, such as pronation-external rotation, and rarely occurs without ankle fracture. The diagnosis is not simple, and ideal management of the various presentations of syndesmotic injury remains controversial to this day. Anatomical restoration and stabilization of the disrupted tibiofibular syndesmosis is essential to improve functional outcomes. In such an injury, including inadequately treated, misdiagnosed and correctly diagnosed cases, a chronic pattern characterized by persistent ankle pain, function disability and early osteoarthritis can result. This paper reviews anatomical and biomechanical characteristics of this syndesmosis, the mechanism of its acute injury associated to fractures, radiological and arthroscopic diagnosis and surgical treatment.
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Affiliation(s)
| | - Massimo De Filippo
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Daniele Casalini
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Alberto Longhi
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Fabrizio Tacci
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Rocco Perotta
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Francesco Pagnini
- Department of Medicine and Surgery, University of Parma, Parma 43126, Italy
| | - Silvio Tocco
- Centro Riabilitativo della Mano e Arto Superiore, Parma 43121, Italy
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Elghazy MA, Hagemeijer NC, Guss D, El-Hawary A, Johnson AH, El-Mowafi H, DiGiovanni CW. Screw versus suture button in treatment of syndesmosis instability: Comparison using weightbearing CT scan. Foot Ankle Surg 2021; 27:285-290. [PMID: 33422428 DOI: 10.1016/j.fas.2021.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/01/2020] [Accepted: 01/02/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The superiority of screw or suture button fixation for syndesmotic instability remains debatable. Our aim is to compare radiographic outcomes of screw and suture button fixation of syndesmotic instability using weight bearing CT scan (WBCT). METHODS Twenty patients with fixation of unilateral syndesmotic instability were recruited and divided among two groups (screw = 10, suture button = 10). All patients had WBCT of both ankles ≥12 months postoperatively. RESULTS In suture button group, injured side measurements were significantly different from normal side for syndesmotic area (P = 0.003), fibular rotation (P = 0.004), anterior difference (P = 0.025) and direct anterior difference (P = 0.035). In screw group, syndesmotic area was the only significantly different measurement (P = 0.006). CONCLUSION While both screw and suture button didn't completely restore the syndesmotic area as compared to the contralateral uninjured ankle, external malrotation of the fibula was uniquely associated with suture button fixation. LEVEL OF EVIDENCE III Retrospective Cohort Study.
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Affiliation(s)
- Mohamed Abdelaziz Elghazy
- Department of Orthopedic Surgery, Faculty of Medicine, Mansoura University, 12 El-Gomhoriya Street, Mansoura University Hospital, Mansoura, Dakahliya 35516, Egypt; Foot and Ankle Research and Innovation Laboratory, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
| | - Noortje C Hagemeijer
- Foot and Ankle Research and Innovation Laboratory, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Daniel Guss
- Foot and Ankle Research and Innovation Laboratory, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA; Foot and Ankle Service, Department of Orthopedic Surgery, Massachusetts General Hospital and Newton-Wellesley Hospital, Boston, USA
| | - Ahmed El-Hawary
- Department of Orthopedic Surgery, Faculty of Medicine, Mansoura University, 12 El-Gomhoriya Street, Mansoura University Hospital, Mansoura, Dakahliya 35516, Egypt
| | - Anne H Johnson
- Foot and Ankle Service, Hospital of Special Surgery, New York, USA
| | - Hani El-Mowafi
- Department of Orthopedic Surgery, Faculty of Medicine, Mansoura University, 12 El-Gomhoriya Street, Mansoura University Hospital, Mansoura, Dakahliya 35516, Egypt
| | - Christopher W DiGiovanni
- Foot and Ankle Research and Innovation Laboratory, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA; Foot and Ankle Service, Department of Orthopedic Surgery, Massachusetts General Hospital and Newton-Wellesley Hospital, Boston, USA
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Effectiveness of the TightRope® Fixation in Treating Ankle Syndesmosis Injuries: A Critically Appraised Topic. J Sport Rehabil 2021; 30:676-679. [PMID: 33626498 DOI: 10.1123/jsr.2020-0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/04/2020] [Accepted: 10/28/2020] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Ankle fractures are a frequent occurrence, and they carry the potential for syndesmosis injury. The syndesmosis is important to the structural integrity of the ankle joint by maintaining the proximity of the tibia, fibula, and talus. Presently, the gold standard for treating an ankle syndesmosis injury is to insert a metallic screw through the fibula and into the tibia. This technique requires a second intervention to remove the hardware, but also carries an inherent risk of breaking the screw during rehabilitation. Another fixation technique, the Tightrope™, has gained popularity in treating ankle syndesmosis injuries. The TightRope™ involves inserting Fiberwire® through the tibia and fibula, which allows for stabilization of the ankle mortise and normal range of motion. Clinical Question: In patients suffering from ankle syndesmosis injuries, is the Tightrope™ ankle syndesmosis fixation system more effective than conventional screw fixation at improving return to work, pain, and patient-reported outcome measures? Summary of Key Findings: Five studies were selected to be critically appraised. The PEDro checklist was used to score 2 randomized control trials, and the Downs & Black checklist was used to score the cohort study on methodology and consistency. Two systematic reviews were also appraised. All 5 articles demonstrated support for using the TightRope™ fixation. Clinical Bottom Line: There is moderate evidence to support the use of the TightRope™ syndesmosis fixation system, as it provides both clinician- and patient-reported outcomes that are similar to those using the conventional metallic screw, with a shortened time to recover and return to activity. Strength of Recommendation: Grade A evidence exists in support of using the TightRope™ fixation system in place of the metallic screw following ankle syndesmosis injury.
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Biomechanical comparison of suture-button, bioabsorbable screw, and metal screw for ankle syndesmotic repair: A meta-analysis. Foot Ankle Surg 2021; 27:117-122. [PMID: 32466876 DOI: 10.1016/j.fas.2020.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/21/2020] [Accepted: 03/24/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND To compare biomechanically metal screw fixation to suture-button or bioabsorbable screw fixation for ankle syndesmotic injuries. METHODS A literature search of the comparison studies in Pubmed and Google Scholar was conducted. The biomechanical outcomes of interest were syndesmotic stability in the coronal, sagittal, and axial planes as well as torque and rotation at failure. RESULTS A total of 11 cadaveric studies were included. In the suture-button group, coronal displacement (MD 1.72mm, p = 0.02) and sagittal displacement (MD 2.65mm, p = 0.0003) were increased relative to the metal screw group. In contrast, no difference was found with axial rotation (MD 0.35 degrees, p = 0.57). Bioabsorbable screws exhibited equivalent failure torque (MD -3.04Nm, p = 0.53) and rotation at failure (MD 3.77 degrees, p = 0.48) in comparison to metal screws. CONCLUSIONS Suture-button provide less rigidity when compared to metal screw fixation. They afford flexible syndesmotic micromotion which may more closely resemble a physiological state and be helpful for ligament healing. Bioabsorbable screws demonstrate similar mechanical strength properties to metal screws.
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Arthroscopic treatment of tibial eminence fractures using double-loop endobutton device: Surgical technique and short-term treatment outcomes. Jt Dis Relat Surg 2020; 31:456-462. [PMID: 32962575 PMCID: PMC7607944 DOI: 10.5606/ehc.2020.75636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to explain the arthroscopic surgical technique of double-loop endobutton device for tibial eminence fractures and share the outcomes of this treatment method. Patients and methods
Thirteen patients (10 males, 3 females; mean age 19.9±5.6 years; range, 14 to 34 years) with tibial eminence fractures type II, IIIa, and IIIb were analyzed retrospectively between March 2017 and March 2019. Knee laxity, Tegner Lysholm knee scores, the International Knee Documentation Committee (IKDC) scores, knee mobility, Lachman test, and bone union were analyzed after the arthroscopic fracture fixation with double-loop endobutton device at first and sixth months after surgery. Results
First month mean IKDC scores were 38.0±7.0 and mean Tegner Lysholm scores were 50.3±5.8. Sixth month mean IKDC scores were 80.2±4.0 and mean Tegner Lysholm scores were 87.1±5.4. All patients showed negative Lachman test and negative pivot-shift test at final follow-up. Radiological bone union without reduction loss was also seen in all patients. Conclusion Using double-loop endobutton device provides successful results to fix tibial eminence fractures.
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Song L, Liao Z, Kuang Z, Qu S, Zhang W, Yuan Y, Fang T. Comparison of tendon suture fixation and cortical screw fixation for treatment of distal tibiofibular syndesmosis injury: A case-control study. Medicine (Baltimore) 2020; 99:e21573. [PMID: 32846766 PMCID: PMC7447365 DOI: 10.1097/md.0000000000021573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate the effectiveness of tendon suture fixation versus cortical screw fixation for the treatment of distal tibiofibular syndesmosis injury.This study recruited 42 patients with Danis-Weber type B, C1 and C2 fractures concomitant with lower tibiofibular syndesmosis injury, who were randomly assigned to 2 groups according to treatment with cortical screw fixation (n = 21) and tendon suture fixation (n = 21). Operation time, intraoperative blood loss, time to full weight-bearing activity, medical cost, ankle function, and ankle pain were compared between the 2 groups.The operation time was significantly less with cortical screw fixation (57.1 ± 5.3 min) than with tendon suture fixation (63.3 ± 6.3 min; p = 0.01), but there was no significant difference in intraoperative blood loss. The time until full weight-bearing was possible was significantly longer after cortical screw fixation (10.9 ± 2.7 weeks) than after tendon suture fixation (7.1 ± 1.9 weeks; P < .001). The medical cost was much greater for cortical screw fixation (1861.6 ± 187.3 USD) than for tendon suture fixation (1209.6 ± 97.6 USD; P < .01). The rate of excellent and good ankle function at 3 months after surgery was significantly higher with tendon suture fixation (71.4%) than with cortical screw fixation (33.3%; P = .03).Tendon suture fixation is associated with quicker recovery of ankle function, shorter time to full weight-bearing, and lower medical cost to the patient compared with screw fixation. Our findings suggest that tendon suture fixation is an effective method for the treatment of tibiofibular syndesmosis injury.
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Differences in gait analysis and clinical outcome after TightRope® or screw fixation in acute syndesmosis rupture: study protocol for a prospective randomized pilot study. Trials 2020; 21:606. [PMID: 32616003 PMCID: PMC7331157 DOI: 10.1186/s13063-020-04550-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 06/23/2020] [Indexed: 02/08/2023] Open
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 3.5 mm 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) DRKS00013562. Registered on July, 12, 2017.
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Kapadia BH, Sabarese MJ, Chatterjee D, Aylyarov A, Zuchelli DM, Hariri OK, Uribe JA, Tsai J. Evaluating success rate and comparing complications of operative techniques used to treat chronic syndesmosis injuries. J Orthop 2020; 22:225-230. [PMID: 32425422 DOI: 10.1016/j.jor.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/09/2020] [Accepted: 04/26/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose To assess the success rate and complications of the surgical interventions used to manage chronic syndesmosis injuries. Methods Multiple online databases were queried to identify studies reporting operative intervention for chronic syndesmosis injuries. Results Modalities of operative fixation include suture-button fixation, arthroscopy and debridement, as well as arthrodesis. The use of operative treatment is effective; however, more direct comparison studies are necessary to evaluate the efficacy of each treatment. Conclusion Various operative procedures have been used for the management of chronic syndesmotic injuries but further prospective studies are necessary to determine the type of treatment that should be indicated.
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Affiliation(s)
- Bhaveen H Kapadia
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Michael J Sabarese
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Dipal Chatterjee
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Alexandr Aylyarov
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Daniel M Zuchelli
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Omar K Hariri
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Jaime A Uribe
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Justin Tsai
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute - New York, NY, USA
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Wen X, Lu J, Zhao H, Li Y, Chang X, Zhang Y, Liang J, Liang X. [Comparison of bioabsorbable screw and metallic screw for Maisonneuve fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:482-488. [PMID: 32291985 DOI: 10.7507/1002-1892.201908118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the clinical and radiographic outcomes of bioabsorbable screw and metallic screw for Maisonneuve fracture. Methods The clinical data of 68 patients of Maisonneuve fracture treated with open reduction and internal fixation between October 2012 and October 2016 were retrospectively analyzed. Metallic screw fixation was used in 37 cases (group A) and absorbable screw fixation was used in 31 cases (group B). There was no significant difference in age, gender, weight, operated side, cause of injury, time from injury to operation, and complications between the two groups ( P>0.05). At last follow-up, the tibiafibular clear space (TFCS), tibiafibular overlap (TFO), medial clear space (MCS), and syndesmotic malreduction rate were recorded. And the dorsiflexion and plantar-flexion range of motion, pain visual analogue scale (VAS) score, ankle and hind foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and Olerud-Molander (OM) score were recorded. Results All patients were followed up 25-43 months, with an average of 32.3 months. There was no significant difference in the operation time between the two groups ( t=1.229, P=0.282). All the fractures healed, and there was no significant difference in fracture healing time between the two groups ( t=1.367, P=0.413). At last follow-up, the syndesmotic malreduction rate of group A was 16.2% (6/37), showing no significant difference when compared with group B [6.2% (2/31)] ( χ 2=1.549, P=0.213). There were 3 complications in group A, 1 was superficial wound infection, 1 was local heterotopic ossification due to failure to remove the screws in time, 1 was local heterotopic ossification of the screws; and there were 2 complications in group B, 1 was rejection and 1 was local heterotopic ossification of the screws. There was no significant difference in the incidence of complications between the two groups ( χ 2=0.068, P=0.794). There was no significant difference in TFCS, MCS, TFO, ankle dorsiflexion and plantar-flexion range of motion, AOFAS score, OM score, and VAS score between the two groups at last follow-up ( P>0.05). Conclusion Compared with metallic screw, absorbable screws provide adequate fixation and functional recovery with avoiding screw removal and lower syndesmotic malreduction.
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Affiliation(s)
- Xiaodong Wen
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Jun Lu
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Hongmou Zhao
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Yi Li
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Xin Chang
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Yan Zhang
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Jingqi Liang
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Xiaojun Liang
- Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
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Grassi A, Samuelsson K, D'Hooghe P, Romagnoli M, Mosca M, Zaffagnini S, Amendola A. Dynamic Stabilization of Syndesmosis Injuries Reduces Complications and Reoperations as Compared With Screw Fixation: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2020; 48:1000-1013. [PMID: 31188642 DOI: 10.1177/0363546519849909] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several devices for obtaining dynamic fixation of the syndesmosis have been introduced in recent years, but their efficacy has been tested in only a few randomized controlled trials (RCTs), without demonstrating any clear benefit over the traditional static fixation with screws. PURPOSE To perform a level 1 meta-analysis of RCTs to investigate the complications, subjective outcomes, and functional results after dynamic or static fixation of acute syndesmotic injuries. STUDY DESIGN Meta-analysis of RCTs. METHODS A systematic literature search was performed of the Medline/PubMed, Cochrane Central Register of Controlled Trials, and Embase electronic databases, as well as ClinicalTrials.gov for unpublished studies. Eligible studies were RCTs comparing dynamic fixation and static fixation of acute syndesmosis injuries. A meta-analysis was performed, while bias and quality of evidence were rated according to the Cochrane Database questionnaire and the Grading of Recommendations Assessment, Development and Evaluation guidelines. RESULTS Dynamic fixation had a significantly reduced relative risk (RR = 0.55, P = .003) of complications-in particular, the presence of inadequate reduction at the final follow-up (RR = 0.36, P = .0008) and the clinical diagnosis of recurrent diastasis or instability (RR = 0.10, P = .03). The effect was more evident when compared with permanent screws (RR = 0.10, P = .0001). The reoperation rate was similar between the groups (RR = 0.64, P = .07); however, the overall risk was reduced after dynamic fixation as compared with static fixation with permanent screws (RR = 0.24, P = .007). The American Orthopaedic Foot & Ankle Society score was significantly higher among patients treated with dynamic fixation-6.06 points higher (P = .005) at 3 months, 5.21 points (P = .03) at 12 months, and 8.60 points (P < .00001) at 24 months-while the Olerud-Molander score was similar. The visual analog scale for pain score was reduced at 6 months (-0.73 points, P = .003) and 12 months (-0.52 points, P = .005), and ankle range of motion increased by 4.36° (P = .03) with dynamic fixation. The overall quality of evidence ranged from "moderate" to "very low," owing to a substantial risk of bias, heterogeneity, indirectness of outcome reporting, and evaluation of a limited number of patients. CONCLUSION The dynamic fixation of syndesmotic injuries was able to reduce the number of complications and improve clinical outcomes as compared with static screw fixation-especially malreduction and clinical instability or diastasis-at a follow-up of 2 years. A lower risk of reoperation was found with dynamic fixation as compared with static fixation with permanent screws. However, the lack of patients or personnel blinding, treatment heterogeneity, small samples, and short follow-up limit the overall quality of this evidence.
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Affiliation(s)
- Alberto Grassi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pieter D'Hooghe
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Matteo Romagnoli
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
| | - Annunziato Amendola
- Michael W. Krzyzewski Human Performance Laboratory, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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Onggo JR, Nambiar M, Phan K, Hickey B, Ambikaipalan A, Hau R, Bedi H. Suture button versus syndesmosis screw constructs for acute ankle diastasis injuries: A meta-analysis and systematic review of randomised controlled trials. Foot Ankle Surg 2020; 26:54-60. [PMID: 30503612 DOI: 10.1016/j.fas.2018.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/04/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ankle syndesmotic injuries can be surgically managed with syndesmosis screws (SS) or suture button (SB) fixation. We performed a meta-analysis of randomized controlled trials (RCTs) aiming to compare the clinical and complication profiles of both modalities. METHODS A multi-database search up to 4th of March 2018 was performed according to PRISMA guidelines. All RCTs comparing both techniques and published in English were included. RESULTS Five RCTs with a total of 280 patients (140 SB, 140 SS) were included for analysis. SB had a statistically significant higher AOFAS score at 1 year (mean difference=5.46, 95% CI=0.40-10.51, p=0.03) and lower implant failure rate (OR=0.03, 95% CI=0.01-0.15, p<0.001). Infection and wound issues were marginally higher with SB (OR=1.4, 95% CI=0.4-4.85, p=0.60). No other parameters showed statistically significant difference. CONCLUSIONS Both constructs yielded similar clinical outcomes. The 1 year AOFAS score was higher in SB but clinical significance is unlikely. SB had significantly fewer implant failures. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.
| | - Mithun Nambiar
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia; Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Kevin Phan
- The Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia; NeuroSpine Surgery Research Group, The Prince of Wales Private Hospital, Sydney, New South Wales, Australia.
| | - Benjamin Hickey
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.
| | | | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia; Monash University, Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia.
| | - Harvinder Bedi
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.
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Fan X, Zheng P, Zhang YY, Hou ZT. Dynamic Fixation versus Static Fixation in Treatment Effectiveness and Safety for Distal Tibiofibular Syndesmosis Injuries: A Systematic Review and Meta-Analysis. Orthop Surg 2019; 11:923-931. [PMID: 31823499 PMCID: PMC6904666 DOI: 10.1111/os.12523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 07/11/2019] [Accepted: 07/28/2019] [Indexed: 12/26/2022] Open
Abstract
To compare the effectiveness and safety of dynamic fixation (DF) and static fixation (SF) in distal tibiofibular syndesmosis injuries (DTSI) by a system review and meta-analysis. PubMed, Cochrane, and EMBASE were systematically searched by computer to select clinical randomized controlled trials (RCT) and cohort trials comparing DF and SF in treating patients with DTSI. RCT and cohort trials comparing DF and SF for patients with DTSI were included. Inclusion criteria: (i) prospective or retrospective study of patients with DTSI; (ii) patients were diagnosed as having DTSI by imageology and only received DF treatment or SF treatment; (iii) the study compared DF and SF in DTSI; and (iv) one or more of the following outcomes were reported: ankle joint functional score, surgical complications, malreduction of syndesmosis, and second operations. Exclusion criteria: (i) non-human studies; (ii) DTSI patients accompanied with other complications or other joints injuries; and (iii) full text unavailable. RevMan V5.3 software was used to perform the statistical analysis. Outcomes analyzed by Revman software showed that there were no statistically significant differences between DF and SF in the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (MD, 1.90; 95% CI, -0.23 to 4.03; P = 0.08; I2 = 0%), Olerud-Molander (OM) score (MD, 1.92; 95% CI, -7.96 to 11.81; P = 0.70; I2 = 55%), incidence of syndesmotic malreduction (RR, 0.19; 95% CI, 0.03 to 1.09; P = 0.06; I2 = 0%), and overall postoperative complication rate (RR, 0.30; 95% CI, 0.09 to 0.99; P = 0.05, I2 = 75%) and the rate of second procedure was significantly lower with DF (RR, 0.17; 95% CI, 0.07 to 0.43; P = 0.0002, I2 = 54%). Compared to SF, DF has an advantage, with a low rate of second procedures to treat DTSI.
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Affiliation(s)
- Xiao Fan
- Traditional Chinese Medicine Department, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
| | - Peng Zheng
- Orthopaedic Department, Traditional Chinese Medicine Hospital of Qingdao West Coast New Area, Qingdao, Shandong Province, China
| | - Ying-Yu Zhang
- Traditional Chinese Medicine Department, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
| | - Zeng-Tao Hou
- Orthopaedic Department, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
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Chang AL, Mandell JC. Syndesmotic Ligaments of the Ankle: Anatomy, Multimodality Imaging, and Patterns of Injury. Curr Probl Diagn Radiol 2019; 49:452-459. [PMID: 31668368 DOI: 10.1067/j.cpradiol.2019.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 12/17/2022]
Abstract
Injuries to the syndesmotic ligaments of the ankle or "high ankle sprains" are common in acute ankle trauma but can be difficult to diagnose both clinically and on imaging. Missed injuries to the syndesmosis can lead to chronic ankle instability, which can cause persistent pain and lead to early osteoarthritis. This review will illustrate the anatomy of the syndesmotic ligamentous complex, describe radiographic, CT, and MR imaging of the syndesmosis, demonstrate typical mechanisms of injuries and associated fracture patterns, and provide an overview of important management considerations.
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Affiliation(s)
- Andrew L Chang
- Long Beach Veteran Affairs, Imaging Service, Long Beach, CA.
| | - Jacob C Mandell
- Brigham and Women's Hospital, Division of Musculoskeletal radiology imaging and intervention, Boston, MA
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47
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McKenzie AC, Hesselholt KE, Larsen MS, Schmal H. A Systematic Review and Meta-Analysis on Treatment of Ankle Fractures With Syndesmotic Rupture: Suture-Button Fixation Versus Cortical Screw Fixation. J Foot Ankle Surg 2019; 58:946-953. [PMID: 31474406 DOI: 10.1053/j.jfas.2018.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Indexed: 02/03/2023]
Abstract
Ankle fractures accompanied by syndesmotic rupture are a complex challenge for orthopedic surgeons. Sufficient reduction and stabilization of the syndesmosis are important to prevent early degeneration of the ankle joint and to optimize clinical outcomes. The purpose of the study was to systematically review the literature comparing the suture-button fixation method with the cortical screw fixation method when treating syndesmotic rupture. For this, a systematic review of the literature was performed that included Cochrane, PubMed, and Embase. The following search terms were used: ankle fractures, syndesmosis rupture, tibiofibular syndesmosis injury, ankle joint, tightrope, and suture button. Inclusion criteria were comparison studies, acute ankle fractures with syndesmotic rupture, adult patients, and Coleman score >60. Cadaveric studies, chronic instability, open fractures, polytrauma, and arthropathies were exclusion criteria. Two investigators independently reviewed titles and relevant abstracts. Reoperation and malreduction rates were compared in a meta-analysis. Six studies with 275 patients were included: 2 randomized controlled trials and 2 prospective and 2 retrospective cohort studies. All studies used similar surgical techniques. Functional outcomes (American Orthopedic Foot and Ankle Society scale and the Olerud-Molander score) were not quantitatively comparable. No significantly less number of malreduction events were detected in the suture-button group (risk ratio = 0.19, 95% confidence interval 0.03 to 1.04, p = .06). Significantly lower reoperation rate was detected in the suture-button group (risk ratio = 0.21, 95% confidence interval 0.06 to 0.69, p = .01). We conclude that the suture-button technique showed a significantly lower reoperation rate and tendency toward less malreduction and better American Orthopedic Foot and Ankle Society scale scores. This finding is clinically relevant; however, this conclusion is primarily based on 2 studies, and therefore the interest for further research increases.
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Affiliation(s)
- Alexandra C McKenzie
- Medical Student, Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Denmark
| | - Kristian E Hesselholt
- Medical Student, Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Denmark
| | - Morten S Larsen
- Surgeon and Associate Professor, Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Denmark
| | - Hagen Schmal
- Surgeon and Professor, Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Denmark.
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48
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Diagnosis and treatment of ankle syndesmosis injuries with associated interosseous membrane injury: a current concept review. INTERNATIONAL ORTHOPAEDICS 2019; 43:2539-2547. [PMID: 31440891 DOI: 10.1007/s00264-019-04396-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 08/14/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Tibiofibular syndesmosis injury leads to ankle pain and dysfunction when ankle injuries are not treated properly. Despite several studies having been performed, many questions about diagnosis and treatment remain unanswered, especially in ankle syndesmosis injury with interosseous membrane injury. Therefore, the purpose of this study was to help guide best practice recommendations. METHODS This review explores the mechanism of injury, clinical features, diagnosis methods, and the treatment strategy for ankle syndesmosis injury with interosseous membrane injury to highlight the current evidence in terms of the controversies surrounding the management of these injuries. RESULTS Radiological and CT examination are an important basis for diagnosing ankle syndesmosis injury. Physical examination combined with MRI to determine the damage to the interosseous membrane is significant in guiding the treatment of ankle syndesmosis injury with interosseous membrane injury. In the past, inserting syndesmosis screws was the gold standard for treating ankle syndesmosis injury. However, there were increasingly more controversies regarding loss of reduction and broken nails, so elastic fixation has become more popular in recent years. CONCLUSIONS Anatomical reduction and effective fixation are the main aspects to be considered in the treatment of ankle syndesmosis injury with interosseous membrane injury and are the key to reducing postsurgery complications.
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Jia Z, Cheng J, Zhong H, Xiao T, Ren J, Lin Y, Huang W, Liang Y, Liu Q, Zhang X. Titanium cable isotonic annular fixation system for the treatment of distal tibiofibular syndesmosis injury. Am J Transl Res 2019; 11:4967-4975. [PMID: 31497213 PMCID: PMC6731404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
Distal tibiofibular syndesmosis injury (DTS) occurs frequently with ankle sprains. Current treatments pose several limitations including causing soft tissue irritation, bringing damage to fixation secondary to weight-bearing, and requiring follow-up surgeries. Here, we investigated the clinical effects of a new technique, titanium cable isotonic annular fixation, for the treatment of DTS injury. From January 2015 to June 2017, 36 patients with ankle fractures and DTS injuries had their fractures repaired with the titanium cable isotonic annular fixation system. Recovery was scored by the AOFAS ankle function score system. We also assessed the differences in ankle motion between healthy and operative joints, and recorded the complications. All patients recovered from surgery without any serious complications. We followed all the cases for 18-25 months with an average follow-up of 21.26±3.23 months. 12 months after the operation, X-ray images showed that the titanium cables were fixed in the correct position without any fracture or loosening. Additionally, no degeneration or traumatic arthritis was observed in the ankle joint. There were no incision or bone mineral density changes between the titanium fix and tibiofibular bones. Nearly all patients recovered well except for three who developed inflammation and infection. However, these three patients recovered following 1 week of intravenous antibiotics and local radiofrequency physiotherapy. According to the AOFAS scoring system, all patients achieved satisfactory recovery 12 months post operation. Our titanium cable isotonic annular fixation system has both the advantages of elastic and rigid fixations. It can restore isotonic strength of the distal tibiofibular joint, and its biomechanical performance approaches normal physiological function. After the operation, patients tolerated weight-bearing exercise and recovered joint mobility. Finally, there is no need to remove the distal tibiofibular implant after 12 weeks. Overall, it is a highly effective surgical method to treat DTS injury.
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Affiliation(s)
- Zhaofeng Jia
- Department of Osteoarthropathy, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and TechnologyShenzhen 518035, Guangdong Province, China
| | - Jiwu Cheng
- Department of Osteoarthropathy, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and TechnologyShenzhen 518035, Guangdong Province, China
| | - Haiyan Zhong
- Department of Osteoarthropathy, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and TechnologyShenzhen 518035, Guangdong Province, China
| | - Tinghui Xiao
- Department of Osteoarthropathy, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and TechnologyShenzhen 518035, Guangdong Province, China
| | - Jinke Ren
- Department of Osteoarthropathy, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and TechnologyShenzhen 518035, Guangdong Province, China
| | - Yimiao Lin
- Department of Osteoarthropathy, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and TechnologyShenzhen 518035, Guangdong Province, China
| | - Wenjun Huang
- Department of Osteoarthropathy, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and TechnologyShenzhen 518035, Guangdong Province, China
| | - Yujie Liang
- Department of Chemistry, The Chinese University of Hong KongShatin, Hong Kong SAR, China
| | - Qisong Liu
- Institute for Regenerative Medicine, Texas A&M Health Science Center College of MedicineTemple, TX 76502, USA
| | - Xiaoming Zhang
- Department of Osteoarthropathy, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University and The First Affilliated Hospital of Southern University of Science and TechnologyShenzhen 518035, Guangdong Province, China
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50
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Stiene A, Renner CE, Chen T, Liu J, Ebraheim NA. Distal Tibiofibular Syndesmosis Dysfunction: A Systematic Literature Review of Dynamic Versus Static Fixation Over the Last 10 Years. J Foot Ankle Surg 2019; 58:320-327. [PMID: 30612866 DOI: 10.1053/j.jfas.2018.08.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Indexed: 02/03/2023]
Abstract
The goal of the present work was to perform a systematic review of the literature of the past 10 years regarding dynamic and static fixation of the distal tibiofibular syndesmosis to determine any clinical differences between the 2 procedures. A literature search of the PubMed MEDLINE database was conducted to identify relevant studies related to distal tibiofibular syndesmosis. Studies before January 1, 2007, were excluded to limit the project to the recent literature. Clinical outcomes, device removal rates, time to weightbearing after the initial procedure, and the cost effectiveness of each device were explored. In these 26 studies, 350 patients were treated using a dynamic technique and 845 were treated using a static technique. The weighted American Orthopedic Foot and Ankle Score was 91.70 (standard error [SE] 1.87) for dynamic fixation patients and the weighted average was 86.48 (SE 2.17) for static fixation patients (p = .068). A secondary procedure to remove the fixation device was performed in 7.7% of dynamic fixation patients and in 39.4% of static fixation patients when studies with 100% device removal were excluded (p < .0001). The mean time to weightbearing was 5.96 (SE 0.72) weeks for patients who underwent dynamic fixation and 10.45 (SE 0.99) weeks for those who had static fixation (p = .0002). The cost for dynamic fixation was found to be less than that for static fixation when secondary procedures for device removal were considered. Based on similar clinical functional scores, lower secondary procedure rates, faster time to full weightbearing, and lower costs to patients, dynamic fixation of the distal tibiofibular syndesmosis may be a superior option compared with static fixation.
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Affiliation(s)
- Andrew Stiene
- Medical Student, University of Toledo, College of Medicine and Life Sciences, Toledo, OH
| | - Charles E Renner
- Medical Student, University of Toledo, College of Medicine and Life Sciences, Toledo, OH
| | - Tian Chen
- Assistant Professor, University of Toledo, Department of Mathematics and Statistics, Toledo, OH
| | - Jiayong Liu
- Assistant Professor, University of Toledo Medical Center, Department of Orthopedic Surgery, Toledo, OH.
| | - Nabil A Ebraheim
- Professor, Surgeon, and Chair, University of Toledo Medical Center, Department of Orthopedic Surgery, Toledo, OH
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