A Single-Center Retrospective Study on the Clinical Outcomes of TightRope Fixation Versus Syndesmotic Screw Fixation in the Management of Acute Traumatic Ankle Syndesmotic Injuries

Abstract

Background Ankle fractures are one of the most common presentations in orthopaedic surgery and represent the third most frequent musculoskeletal injury in the elderly population. Syndesmotic injuries can be associated with ankle fractures, and surgical intervention is critical in these injuries to restore stability and prevent long-term disability. Traditionally, syndesmotic screw fixation has been the standard treatment for acute traumatic syndesmotic injuries, but controversies regarding this fixation method remain. Over recent years, the TightRope system (Arthrex, Florida, US) has gained popularity as a dynamic alternative, offering the advantage of restoring anatomical function while maintaining reduction. The optimal surgical fixation method for managing syndesmotic injuries remains a topic of ongoing debate within orthopaedic practice. Therefore, this study aims to compare the clinical outcomes of these two fixation methods to provide further guidance on their use in managing acute traumatic syndesmotic injuries. Methods A retrospective cohort study was performed for all patients with ankle syndesmotic injuries who underwent surgical fixation using either TightRope devices or syndesmotic screws at Buckinghamshire Healthcare NHS Trust between June 2020 and June 2023, identified through the BlueSpier electronic record system (Bluespier, Droitwich, United Kingdom). Data on demographics and surgical details were extracted from electronic medical records while radiographic images were systematically reviewed to confirm eligibility for inclusion. Clinic letters were also reviewed for complications and reasons for metalwork removal. Results A total of 217 patients met the eligibility criteria for this study, with 132 (61%) females and 85 (39%) males, aged between 13 and 93 years (mean age: 49 years). Of the cohort, 28 (13%) underwent syndesmotic fixation with TightRope devices while 189 (87%) were treated with syndesmotic screws. Metalwork removal was required in 11% of TightRope cases (3 patients) and 28% of syndesmotic screw cases (52 patients). The most common reason for metalwork removal in our study cohort was for broken or loosened screw(s), followed by discomfort and patient preferences. The metalwork removal rates in our study cohort are consistent with those reported in the current literature. Conclusion In conclusion, our study found that the use of TightRope devices is associated with lower removal rates in comparison to syndesmotic screws. This finding is consistent with those reported in the current literature. The most common documented reason for metalwork removal in our study cohort was due to screw breakage or loosening. Although emerging evidence suggests that routine removal of syndesmotic screws may not be necessary, given the lack of consensus regarding the routine removal of syndesmotic screws, decisions for metalwork removal should be tailored by clinical judgement and individual patient needs. Despite its limitations, this study contributes valuable insights into the outcomes and metalwork removal rates associated with syndesmotic fixation methods in the management of acute ankle fractures with syndesmotic injuries.

Keywords: ankle; fractures; surgery; syndesmosis; syndesmotic screws; tightrope.

Figure 1. Schematic diagram illustrating the study methodology