Abstract
The suture button (SB) device was introduced to negate the need for routine hardware removal in the treatment of syndesmosis injuries. However, a considerable SB removal rate has been reported, and the impact of removal is unknown. This study aimed to evaluate the radiographic and clinical outcomes after removal of SB for syndesmosis fixation. A total of 36 patients who underwent removal surgery after syndesmosis fixation using SB were identified. The mean postoperative time to removal was 12.2 months. On a plain radiograph, tibiofibular clear space (TFCS) was measured and compared at three follow-up time points. In patients with computed tomography (CT) imaging (n = 18), the anterior-to-posterior (A/P) ratio was measured to evaluate changes in quality of reduction. Additionally, clinical outcomes were assessed. There were no significant differences in TFCS between the three follow-up periods. None of the patients exhibited recurrent diastasis after SB removal. Although CT analysis demonstrated malreduction in six patients (33.3%), five of six patients had a subsequent spontaneous reduction of the syndesmosis. Clinically, all patients described the resolution of symptoms related to painful hardware at the final follow-up. Our results demonstrate that SB removal at one year following syndesmosis fixation leads to improved clinical symptoms without negatively impacting the quality of syndesmosis reduction.
Highlights
Syndesmosis injury occurs in 13% of ankle fractures, and one-fifth of all ankle fractures may require surgical fixation [1]
The majority of patients complained of lateral-sided discomfort related to the suture button (SB) or plate (n = 31, 94%), while two patients (6%) complained of discomfort related to the SB or plate (n = 31, 94%), while two patients (6%) complained of medial-sided discomfort associated with the oblong button
There were no significant differences between the three follow-up periods
Summary
Syndesmosis injury occurs in 13% of ankle fractures, and one-fifth of all ankle fractures may require surgical fixation [1] Since these injuries are associated with altered tibiofibular joint kinematics, achieving and maintaining accurate syndesmotic reduction is essential in restoring ankle function and preventing ankle osteoarthritis [2]. More recent computed tomography (CT) studies have demonstrated that screw removal may allow for a spontaneous reduction of a malreduced syndesmosis [6,7]. These conflicting results and opinions have raised the need for alternative fixation systems
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