Repair of the Tibiofibular Syndesmosis with a Flexible Implant

Abstract

Fractures of the adult ankle with disruption of the tibiofibular syndesmosis require adequate stabilization of the ankle mortise to ensure satisfactory healing of the syndesmotic ligaments. Numerous internal fixation techniques for stabilization of the syndesmosis have been used. However, most techniques require partial device removal before weight bearing can be initiated. The "flexible syndesmosis repair" uses simple, inexpensive, readily available synthetic materials to restore distal tibiofibular stability. Once early fracture healing has been obtained, weight bearing is begun (average 6 weeks). Biomechanical testing on paired cadaver ankles demonstrated a suture tensile strength of 60 lbs and consistent suture-button strength of 49 lbs, whereas tricortical screw fixation was found to have a higher 82 lbs average pull-out strength, but demonstrated a wide variability depending on bone quality. Twelve patients have been managed with flexible syndesmosis repair and followed for 2-4 years. All fractures have healed without deformity and there are no cases of mortise instability. Subsequent analysis of devices removed 8-12 months following implantation has shown that all have remained intact without failure. The flexible syndesmosis repair is a reliable, stable way to restore syndesmosis integrity, allowing early weight bearing without need for interim surgery.