4. 2011: Schepers T, et al
Complications of Syndesmosis Screw Removal
76 patients
N=7 (9%) wound infection
N=5 (7%) recurrent diastasis
N=5 (7%) occult broken screw
TOTAL: 22% complication rate
5. 2007: S. Hakkalamani, et al
Syndesmotic Screw Removal in Weber ‘C’ fractures
42 patients
N=6 wound infection (14%)
N=4 instability pain (10%)
N=1 DVT
N=1 occult broken screw
TOTAL: 26% complication rate
6. 2007: Wahlquist M. Late Diastasis following
Syndesmotic Screw Removal
21 patients
Average 2mm widening
of tibio-fibular clear space
38% of patients symptomatic
7. 2009. Hamid N, et al Outcome after fixation of ankle
fractures with an injury to the syndesmosis. The effect
of a syndesmosis screw
52 patients
27 intact screws (AOFAS score 83)
15 elective removal (AOFAS score 86)
10 broken screws (AOFAS score 92)
Average 30 (12-56) month follow-up
8. 2012. Mendelsohn ES, et al. The Effect of Obesity on
Early Failure after Operative Syndesmosis Injuries
Re-operations for displacement:
15 in 102 (15%) obese patients vs.
2 in 111 (2%) non-obese patients
Obese: 12 times more likely to displace
9. 2003: Thornes B, Walsh A, Hislop M, Murray P, O’Brien M
Suture-Endobutton Fixation of Ankle Tibio-Fibular
Diastasis: A Cadaver Study
2005: Thornes B, Shannon F, Guiney AM, Masterson E
Suture-Button Syndesmosis Fixation. Accelerated
Rehabilitation and Improved Outcomes
2006: Thornes B, McCartan D
Ankle Syndesmosis Injuries Treated with
the TightRope Suture-Button Kit
14. 2009: Cottom JM
Comparison of suture-button to traditional screw
fixation in 50 cases
25 Tightrope vs 25 Screw cohorts
Similar ankle outcome scores
68% removal rate with screws
0% removal rate with TightRope
15. 2009: Coetzee JC
Syndesmoses disruptions: A
prospective, randomized study of screw fixation vs
TightRope®
12 TightRope vs 12 Screw cases
12 month AOFAS score: 85 (TightRope)
76 (Screw)
Better range of motion in TightRope group
16. 2011: DeGroot H, et al
Outcomes of Suture Button Repair of the
Distal Tibiofibular Syndesmosis
24 TightRope cases
AOFAS score: 94 (71-100) at 18 months
6 cases: local irritation from suture knot
elective removal without difficulty
17. 2011: DeGroot H, et al
Outcomes of Suture Button Repair of the
Distal Tibiofibular Syndesmosis
DISCUSSION
“In summary, we believe the suture button device represents a
viable alternative to screw fixation for syndesmosis injuries.
Because of the ease of use of the device and the ability to
allow full weight-bearing without concerns about implant
breakage, we feel that suture-button fixation is superior to
conventional metallic screws.”
18. 2012: Naqvi GA, Shafqat A, Awan N
Tightrope fixation of ankle syndesmosis injuries:
Clinical outcome, complications & technique modification
49 TightRope cases
AOFAS score 86 (78-93) at 6 months
3 cases of implant removal (irritation/infection)
Senior author recommends burying lateral
suture tails sub-perisoteally
21. 2006: Gardner M, et al
Malreduction of the Tibiofibular Syndesmosis in
Ankle Fractures
52% incongruity of fibula within
incisura on postop CT scan
23. 2008. Ho JY et al. Mid-Diaphyseal Fibular
Fractures with Syndesmotic Disruption:
Should We Plate the Fibula?
Cadaver study, 8 paired samples
• Rotational stability
• Load-to-failure
• Stiffness
Better with additional fibular plating vs.
syndesmosis (screw) fixation alone
Therefore: if you can, FIX THE FIBULA
27. 2010. Craik JD, et al. The Financial Impact of
disatasis screw versus TightRope fixation of
unstable syndesmosis injuries of the ankle
2 year audit of 79 cases
Ave. 5.9 follow-up OPD appointments (Screw)
Ave. 4.0 follow-up OPD appointments (TightRope)
TightRope saves:
34 theatre slots per annum
68 OPD appointments
£12,138 annual saving (60% of staff nurse salary in UK)