A case series comparing ankle motion during functional activities between syndesmotic screw or suture-button fixation methods for distal tibiofibular syndesmosis instability

Abstract

Distal tibiofibular syndesmosis injuries can be stabilized with syndesmotic screws or suture-buttons. The objective was to compare ankle motion during gait and a step-down task between patients that had syndesmotic screw or suture-button fixation and healthy adults. This case series included two participants who received a syndesmotic screw and two participants that received a suture-button to fixate the distal tibiofibular syndesmosis. Time from surgery was 2 to 5 years. Ankle angles were measured during gait and a step-down task using an optical motion capture system and force plates. Peak angles and angle waveforms were compared to healthy adults (gait n=56, step-down n=14) using descriptive statistics. There was decreased ankle plantarflexion during gait for one participant that had a syndesmotic screw and one participant that had a suture-button compared to healthy adults. During step-down, there was decreased ankle dorsiflexion in three participants (1 suture-button, 2 syndesmotic screw) and decreased ankle eversion for both participants that had syndesmotic screws. There was no clear pattern of which surgical technique resulted in improved ankle motion. Other factors likely played a role in limiting ankle motion such as injury severity. Future studies should further compare ankle motion during functional activities between these surgical techniques in larger samples.