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Jeyaraman M, Jeyaraman N, Iyengar KP, Selvaraj P, Ramasubramanian S, Jain VK. Assessment of Needlestick and Sharps Injuries (NSSIs) Amongst Orthopaedic Surgeons in Clinical Practice: A Pan-India Cross-Sectional Study. Indian J Orthop 2024; 58:1239-1247. [PMID: 39170655 PMCID: PMC11333663 DOI: 10.1007/s43465-024-01178-4] [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: 11/13/2023] [Accepted: 05/04/2024] [Indexed: 08/23/2024]
Abstract
Introduction Needlestick and sharps injuries (NSSIs) represent an existential occupational hazard risk to orthopaedic surgeons during their career due to the interaction with various devices, instruments and bone fragments. Consequently, NSSIs have the potential to transmit infections such as Hepatitis B (HBV), Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) leading to serious illness. The purpose of this cross-sectional study was to identify the clinical settings predisposing orthopaedic surgeons to NSSIs and assess their adherence to safety protocols in the Indian context. Materials and Methods An online cross-sectional survey of 618 orthopaedic surgeons in India, stratified by experience into two groups: under five years and with 5 years or more was undertaken. The data were collected via an expert-validated online questionnaire to evaluate demographic distribution, injury characteristics, knowledge of safety protocols, and adherence to these protocols. Descriptive statistics summarized the data, Chi-square tests assessed variable associations, and odds ratios were computed for significant variables. Ethical integrity was maintained via electronic informed consent and for confidentiality assurances. Results The study revealed that orthopaedic surgeons with less than 5 years of clinical experience had higher risks for NSSIs as compared to those with 5 or more years of clinical practice. Conversely, the latter group was more susceptible to bone spike injuries and viral positive needlestick incidents. The analysis shows that whilst the more experienced practitioners displayed greater proficiency in the application of universal precautions and NSSI prevention, they were also less likely to report injuries, often due to discomfiture. Risk profiles were consistent across different practice settings and affiliations, regardless of experience level. Conclusion This cross-sectional study reveals less experienced orthopaedic surgeons face higher risks of NSSIs, possibly due to inadequate education or awareness. More experienced practitioners encounter distinct risks, likely owing to long-term exposure and traditional practices. There is an immediate need to raise awareness of the potential risks of NSSIs, enhanced education, appropriate training, collaboration with the hospital risk management team and developing a culture of transparent reporting to mitigate these risks. The emphasis should be on reducing the incidence and fostering open reporting of NSSIs to protect clinicians and promote health safety.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu 600077 India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu 600077 India
| | - Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk Hospitals, Mersey and West Lancashire Teaching NHS Trust, Southport, PR8 6PN UK
| | - Preethi Selvaraj
- Department of Community Medicine, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu 600095 India
| | - Swaminathan Ramasubramanian
- Department of Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, Tamil Nadu 600002 India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
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Rask JP, Duran HT, DeClercq J, Andreae M, Anders S, Banerjee A, Burden AR, Levine AI, Shotwell MS, Sinz EH, Torsher LC, Gaba DM, Weinger MB. Screening for hazardous attitudes among anaesthesiologists: a pilot study. Br J Anaesth 2023; 131:e157-e160. [PMID: 37741719 PMCID: PMC10653638 DOI: 10.1016/j.bja.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 09/25/2023] Open
Affiliation(s)
- John P Rask
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM, USA.
| | - Huong-Tram Duran
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Josh DeClercq
- Center for Research and Innovation in Systems Safety (CRISS), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Andreae
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Shilo Anders
- Center for Research and Innovation in Systems Safety (CRISS), Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arna Banerjee
- Division of Anesthesiology Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Amanda R Burden
- Department of Anesthesiology, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Adam I Levine
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Matthew S Shotwell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth H Sinz
- Department of Anesthesiology and Perioperative Medicine, Medical Simulation Center, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Laurence C Torsher
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - David M Gaba
- Department of Anesthesiology, Stanford University School of Medicine, Center for Immersive and Simulation-based Learning, Li Ka Shing Center for Learning and Knowledge, Stanford, CA, USA
| | - Matthew B Weinger
- Center for Research and Innovation in Systems Safety (CRISS), Vanderbilt Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
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Benzer JK, Meterko M, Singer SJ. The patient safety climate in healthcare organizations (PSCHO) survey: Short-form development. J Eval Clin Pract 2017; 23:853-859. [PMID: 28425580 DOI: 10.1111/jep.12731] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Measures of safety climate are increasingly used to guide safety improvement initiatives. However, cost and respondent burden may limit the use of safety climate surveys. The purpose of this study was to develop a 15- to 20-item safety climate survey based on the Patient Safety Climate in Healthcare Organizations survey, a well-validated 38-item measure of safety climate. METHODS The Patient Safety Climate in Healthcare Organizations was administered to all senior managers, all physicians, and a 10% random sample of all other hospital personnel in 69 private sector hospitals and 30 Veterans Health Administration hospitals. Both samples were randomly divided into a derivation sample to identify a short-form subset and a confirmation sample to assess the psychometric properties of the proposed short form. RESULTS The short form consists of 15 items represented 3 overarching domains in the long-form scale-organization, work unit, and interpersonal. CONCLUSION The proposed short form efficiently captures 3 important sources of variance in safety climate: organizational, work-unit, and interpersonal. The short-form development process was a practical method that can be applied to other safety climate surveys. This safety climate short form may increase response rates in studies that involve busy clinicians or repeated measures.
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Affiliation(s)
- Justin K Benzer
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA.,US Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA.,Department of Psychiatry, University of Texas Dell Medical School, Austin, Texas, USA
| | - Mark Meterko
- Department of Veterans Affairs, Performance Measurement, VHA Office of Reporting, Analytics, Performance, Improvement and Deployment (RAPID), Bedford, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sara J Singer
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
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Bruinsma WE, Becker SJE, Guitton TG, Kadzielski J, Ring D. How prevalent are hazardous attitudes among orthopaedic surgeons? Clin Orthop Relat Res 2015; 473:1582-9. [PMID: 25273970 PMCID: PMC4385355 DOI: 10.1007/s11999-014-3966-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND So-called "hazardous attitudes" (macho, impulsive, antiauthority, resignation, invulnerable, and confident) were identified by the Federal Aviation Administration and the Canadian Air Transport Administration as contributing to road traffic incidents among college-aged drivers and felt to be useful for the prevention of aviation accidents. The concept of hazardous attitudes may also be useful in understanding adverse events in surgery, but it has not been widely studied. QUESTIONS/PURPOSES We surveyed a cohort of orthopaedic surgeons to determine the following: (1) What is the prevalence of hazardous attitudes in a large cohort of orthopaedic surgeons? (2) Do practice setting and/or demographics influence variation in hazardous attitudes in our cohort of surgeons? (3) Do surgeons feel they work in a climate that promotes patient safety? METHODS We asked the members of the Science of Variation Group-fully trained, practicing orthopaedic and trauma surgeons from around the world-to complete a questionnaire validated in college-aged drivers measuring six attitudes associated with a greater likelihood of collision and used by pilots to assess and teach aviation safety. We accepted this validation as applicable to surgeons and modified the questionnaire accordingly. We also asked them to complete the Modified Safety Climate Questionnaire, a questionnaire assessing the absence of a safety climate that is based on the patient safety cultures in healthcare organizations instrument. Three hundred sixty-four orthopaedic surgeons participated, representing a 47% response rate of those with correct email addresses who were invited. RESULTS Thirty-eight percent (137 of 364 surgeons) had at least one score that would have been considered dangerously high in pilots (> 20), including 102 with dangerous levels of macho (28%) and 41 with dangerous levels of self-confidence (11%). After accounting for possible confounding variables, the variables most closely associated with a macho attitude deemed hazardous in pilots were supervision of surgical trainees in the operating room (p = 0.003); location of practice in Canada (p = 0.059), Europe (p = 0.021), and the United States (p = 0.005); and being an orthopaedic trauma surgeon (p = 0.046) (when compared with general orthopaedic surgeons), but accounted for only 5.3% of the variance (p < 0.001). On average, 19% of surgeon responses to the Modified Safety Climate Questionnaire implied absence of a safety climate. CONCLUSIONS Hazardous attitudes are common among orthopaedic surgeons and relate in small part to demographics and practice setting. Future studies should further validate the measure of hazardous attitudes among surgeons and determine if they are associated with preventable adverse events. We agree with aviation safety experts that awareness of amelioration of such attitudes might improve safety in all complex, high-risk endeavors, including surgery-a line of thinking that merits additional research.
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Affiliation(s)
- Wendy E. Bruinsma
- />Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Stéphanie J. E. Becker
- />Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA USA
| | - Thierry G. Guitton
- />Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - David Ring
- />Orthopaedic Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA
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Harris JD, Staheli G, LeClere L, Andersone D, McCormick F. What effects have resident work-hour changes had on education, quality of life, and safety? A systematic review. Clin Orthop Relat Res 2015; 473:1600-8. [PMID: 25269530 PMCID: PMC4385350 DOI: 10.1007/s11999-014-3968-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND More than 15 years ago, the Institute of Medicine (IOM) identified medical error as a problem worthy of greater attention; in the wake of the IOM report, numerous changes were made to regulations to limit residents' duty hours. However, the effect of resident work-hour changes remains controversial within the field of orthopaedics. QUESTIONS/PURPOSES We performed a systematic review to determine whether work-hour restrictions have measurably influenced quality-of-life measures, operative and technical skill development, resident surgical education, patient care outcomes (including mortality, morbidity, adverse events, sentinel events, complications), and surgeon and resident attitudes (such as perceived effect on learning and training experiences, personal benefit, direct clinical experience, clinical preparedness). METHODS We performed a systematic review of PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Google Scholar using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were any English language peer-reviewed articles that analyzed the effect(s) of orthopaedic surgery resident work-hour restrictions on patient safety, resident education, resident/surgeon quality of life, resident technical operative skill development, and resident surgeon attitudes toward work-hour restrictions. Eleven studies met study inclusion criteria. One study was a prospective analysis, whereas 10 studies were of level IV evidence (review of surgical case logs) or survey results. RESULTS Within our identified studies, there was some support for improved resident quality of life, improved resident sleep and less fatigue, a perceived negative impact on surgical operative and technical skill, and conflicting evidence on the topic of resident education, patient outcomes, and variable attitudes toward the work-hour changes. CONCLUSIONS There is a paucity of high-level or clear evidence evaluating the effect of the changes to resident work hours. Future research in this area should focus on objective measures that include patient safety as a primary outcome.
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Affiliation(s)
- Joshua D. Harris
- />Department of Orthopedic Surgery, The Methodist Hospital, Houston, TX USA
| | - Greg Staheli
- />Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA USA
| | - Lance LeClere
- />Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA USA
| | - Diana Andersone
- />Holy Cross Orthopedic Institute, 5597 N Dixie Highway, Fort Lauderdale, FL 33334 USA
| | - Frank McCormick
- />Holy Cross Orthopedic Institute, 5597 N Dixie Highway, Fort Lauderdale, FL 33334 USA
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Kadzielski J, McCormick F, Herndon JH, Rubash H, Ring D. Surgeons' attitudes are associated with reoperation and readmission rates. Clin Orthop Relat Res 2015; 473:1544-51. [PMID: 24874115 PMCID: PMC4385371 DOI: 10.1007/s11999-014-3687-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Attitudes influence how people make decisions. In an effort to decrease pilot judgment-related accidents, the Federal Aviation Administration teaches new pilots about hazardous attitudes that are believed to be incompatible with safe flight: macho, impulsive, worry, resignation, self-confidence, and antiauthority. If these attitudes are hazardous for pilots and their passengers, they may also be incompatible with the reliable and safe delivery of surgical care. QUESTIONS/PURPOSES The purposes of this study were (1) to ascertain to what extent surgeons harbor hazardous attitudes; and (2) to determine their relationship, if any, to reoperation and readmission rates. METHODS We selected validated aviation psychology tools that are used to measure these attitudes in pilots. We converted the aviation scenarios to analogous situations for surgeons and invited all surgeons from one academic program to participate in this study. A total of 41 surgeons were eligible to participate; 37 (90%) completed the attitude prevalence protocol and 31 (76%) had complete reoperation and readmission data for the correlation and regression analysis. Attending orthopaedic surgeons completed the Modified Surgeon Hazardous Attitude Scale as well as a series of additional instruments. RESULTS Levels of macho thought to be hazardous in pilots were present in nine (24%) surgeons. Similar, elevated levels of self-confidence were found in three (8%) surgeons. High levels of impulsivity were found in 5% (two surgeons) and high levels of antiauthority were found in 3% (one surgeon). Only one (3%) surgeon reported elevated levels of worry and no surgeon reported hazardous levels of resignation. Thirty percent (11 surgeons) of surgeons harbored at least one elevated attitude level. In a regression model, macho attitude levels predicted 19% of the variation in surgeons' rate of readmissions and reoperations. CONCLUSIONS High levels of hazardous attitudes may not be consistent with the routine delivery of safe surgical care in a teamwork setting where human factors and safe systems are the key to success. Further research is needed to determine if abnormally high levels of these hazardous attitudes impact patient care. LEVEL OF EVIDENCE Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- John Kadzielski
- />Hand and Upper Extremity Surgery, South Shore Orthopedics, 2 Pond Park Road, Suite 102, Hingham, MA 02043 USA
| | | | - James H. Herndon
- />Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Harry Rubash
- />Arthroplasty Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - David Ring
- />Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
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Samora JB, Bashook P, Jones A, Milbrandt T, Mazzocca AD, Quinn RH. Orthopaedic Graduate Medical Education: A Changing Paradigm. JBJS Rev 2014; 2:01874474-201411000-00001. [DOI: 10.2106/jbjs.rvw.n.00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bhardwaj A, Sivapathasundaram N, Yusof M, Minghat A, Swe K, Sinha N. The Prevalence of Accidental Needle Stick Injury and their Reporting among Healthcare Workers in Orthopaedic Wards in General Hospital Melaka, Malaysia. Malays Orthop J 2014; 8:6-13. [PMID: 25279086 PMCID: PMC4181076 DOI: 10.5704/moj.1407.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ABSTRACT Background :Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and general public health. Orthopaedic surgeons may be more prone to NSIs due to the prevalence of bone spikes in the operative field and the use of sharp orthopaedic instruments such as drills, saws and wires. A hospital-based cross sectional study was conducted in the orthopedic wards of Melaka General Hospital. The prevalence of NSIs was 32 (20.9%) and majority of it occurred during assisting in operation theatre 13(37.4%). Among them six (18.8%) were specialist, 12(37.5%) medical officer, 10 (31.2%) house officer and four staff nurses (12.5%). Among the respondents 142 (92.8%) had been immunized against Hepatitis B and 148 (96.7%) participants had knowledge regarding universal precaution. The incidence of NSI among health care workers at orthopaedics ward was not any higher in comparison with the similar studies and it was found out that the prevalence was more in junior doctors compared with specialist and staff nurses and it was statistically significant. KEY WORDS Needle sticks injury, health care workers, and standard precaution.
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Affiliation(s)
- A Bhardwaj
- Department of Orthopaedics, Newcastle University Medicine Malaysia, Johor, Malaysia
| | | | - Mf Yusof
- Department of Orthopaedics, Melaka General Hospital, Melaka, Malaysia
| | - Ah Minghat
- Department of Orthopaedics, Melaka Manipal Medical College, Malaysia
| | - Kmm Swe
- Department of Orthopaedics, Newcastle University Medicine Malaysia, Johor, Malaysia
| | - Nk Sinha
- Department of Orthopaedics, Melaka Manipal Medical College, Malaysia
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Bernard JA, Dattilo JR, Laporte DM. The incidence and reporting of sharps exposure among medical students, orthopedic residents, and faculty at one institution. JOURNAL OF SURGICAL EDUCATION 2013; 70:660-668. [PMID: 24016379 DOI: 10.1016/j.jsurg.2013.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/15/2013] [Accepted: 04/16/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To compare the incidence of sharps injuries among medical students, orthopedic residents/fellows, and orthopedic faculty at one institution and to determine the rate of reporting exposures. DESIGN Cross-sectional survey. Surveys were completed by 44% (53/120) of medical students, 76% (23/30) of residents/fellows, and 56% (17/30) of full-time faculty. SETTING Academic medical center. PARTICIPANTS Medical students, orthopedic surgery residents/fellows, full-time academic orthopedic surgery faculty. RESULTS Twenty-eight percent of medical students, 83% of residents/fellows, and 100% of faculty had been exposed to a sharps injury at some point in their career; 42% of residents/fellows had experienced a sharps exposure within the past year. The most common single instrument responsible for sharps injuries among all groups was the solid-bore needle; students and residents were significantly more likely than faculty to have a sharps injury from a solid-bore needle than all other devices combined (p = 0.04). Medical students were more likely to ignore the exposure than residents/fellows (p = 0.004) or faculty (p = 0.036). Only 12.5% of medical students followed all the steps of the postexposure protocol. CONCLUSION Sharps exposures occur among orthopedic surgeons and their trainees. Interventions are needed to increase safety among residents and medical students. Further research should evaluate factors suppressing medical student reporting of sharps exposures.
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Affiliation(s)
- Johnathan A Bernard
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
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Welck MJ, Ray P. Tibialis anterior tendon entrapment after ankle tightrope insertion for acute syndesmosis injury. Foot Ankle Spec 2013; 6:242-6. [PMID: 23424188 DOI: 10.1177/1938640013477131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ankle syndesmotic injuries often require anatomic reduction and fixation. Syndesmosis screw fixation is commonly used; however, this prevents physiological motion at the joint, often requires a second operation for screw removal, and may limit postoperative weight bearing. The Ankle Tightrope (Arthrex, Naples, FL) was introduced to allow physiological tibiofibular micromotion, early ankle range of motion, and weight bearing, and did not require a second operation for removal. For Maisonneuve injuries, or more severe syndesmosis instability, a second tightrope is required. This is advised to be placed 1 cm above the first with axial divergence in the coronal plane to increase rotational stability. Initial series have shown the main complications of tightrope fixation to be knot prominence or wound complications. Other documented complications include erosion of the buttons into bone, synostosis, and diastasis. This is the first report of tendon entrapment from the medial button. Reasons for this are discussed with suggestions for surgical technique.
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