Does the choice of syndesmotic screw versus suture button in ankle surgery has a silver lining? \u2013 a technical note

Pieter D’Hooghe,Motasem Salameh

doi:10.1186/s40634-020-00279-x

Pieter D’Hooghe, Motasem Salameh

Open Access

https://doi.org/10.1186/s40634-020-00279-x

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Abstract

PurposeUnstable 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.MethodsThe 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.ResultsThe 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.ConclusionThe 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.

Highlights

Ankle injuries are one of the most common sports injuries [9], of which unstable ankle fractures are considered a significant source of morbidity to our athlete population
Since the player’s RTP online statistics showed that he has been regularly playing and scoring. In this technical note, we present the case of a professional football player who sustained an unstable ankle fracture with associated syndesmotic injury
Teramoto et al performed this study on 6 ankles comparing single suture button fixation, double suture button fixation, anatomic suture button and screw fixation

Summary

Introduction

Ankle injuries are one of the most common sports injuries [9], of which unstable ankle fractures are considered a significant source of morbidity to our athlete population. Competitive athletes with associated syndesmotic injury were found less likely to return to play at 1 year [2]. An evidence-based guideline for the management of acute ankle fractures in athletes is lacking, open reduction and internal fixation with 1 or 2 syndesmotic screws are the current golden standard treatment [14]. Ligamentous injuries are known to require more healing time compared to bony fractures. The authors present a novel fixation technique that uses a sequential rigid and dynamic syndesmotic fixation algorithm in an elite football player that sustained an acute ankle fracture with associated syndesmotic injury.

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