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. 2020 Sep 13;7(1):66.
doi: 10.1186/s40634-020-00279-x.

Does the choice of syndesmotic screw versus suture button in ankle surgery has a silver lining? - a technical note

Pieter D'Hooghe  1 , Motasem Salameh  2
Affiliations

Does the choice of syndesmotic screw versus suture button in ankle surgery has a silver lining? - a technical note

Pieter D'Hooghe et al. J Exp Orthop. .

Abstract

Purpose: Unstable ankle fractures with associated syndesmotic injury are of considerable morbidity in the professional athlete population. The use of dynamic suture button versus static syndesmotic screws fixation, rehabilitation protocols and timing to return to play are still areas of debate. We report the use of novel algorithm of sequential static and dynamic syndesmotic fixation in an elite football player with Weber C ankle fracture.

Methods: The patient underwent open reduction and internal fixation for a weber C ankle fracture with associated syndesmotic and deltoid ligament injury. The osteosynthesis included lateral malleolus neutralizing plate, two syndesmotic screws and deltoid anchor repair. At 6 weeks post-operative both syndesmotic screws were removed and one suture button was implanted in the proximal screw hole. After the second operation the patient was allowed full weight bearing and range of motion in all direction with accelerated rehabilitation protocol.

Results: The technique provided satisfactory results. At 4 month the player participated in a 90 min official football match. The fracture healed uneventfully with no recurrent syndesmotic diastasis.

Conclusion: The presented technique of sequential dynamic and static fixation of associated syndesmotic injuries combined advantages of both syndesmotic screws and suture button implants. In an aim to allow earlier return to play in an elite football player. This opens the way for higher level of evidence clinical trials.

Keywords: Ankle fracture; Athlete; Football; Return to play; Screw; Suture button; Syndesmosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Anteroposterior and lateral plain ankle radiographs of the initial injury showing a Weber C ankle fracture subluxation with widened medial clear space, increased tibiofibular clear space, decreased tibiofibular overlap and lateral subluxation of the talus
Fig. 2
Fig. 2
Post-operative anteroposterior and lateral plain ankle radiographs. Osteothynseis with lateral malleolus plate and two syndesmotic quadritcortical screws
Fig. 3
Fig. 3
Anteroposterior and lateral plain ankle radiographs after the second operation demonstrating the exchange of the proximal syndesmotic screw with a suture button
Fig. 4
Fig. 4
Example of recurrent diastasis after removal of syndesmotic screws. a Post-operative anteroposterior and lateral plain ankle radiographs demonstrating lateral malleolus neutralizing plate and syndesmotic screw fixation. b Post-operative anteroposterior and lateral plain ankle radiographs showing recurrent tibio-fibular diastasis after removal of the syndesmotic screw
See this image and copyright information in PMC

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