Effective and Sustainable Syndesmotic Injury Repair using Endobutton and Fiber wire, in Bimalleolar Fractures
Journal of Clinical Orthopaedics | Vol 7 | Issue 1 | Jan-Jun 2022 | page: 135-138 | Vaibhav J. Koli, Prakash D. Samant, Rohit M. Sane, Maitreya J. Patil, Pankaj K. Singh
Author: Vaibhav J. Koli , Prakash D. Samant , Rohit M. Sane , Maitreya J. Patil , Pankaj K. Singh 
 Department of Orthopaedics, D Y Patil University School of Medicine, Navi Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Rohit M Sane,
Department of Orthopaedics, D Y Patil University School of Medicine, Nerul, Navi Mumbai, Maharashtra, India.
Ankle fractures are the most frequent fractures accounting for 10% of all fractures, having an incidence of about 184/100,000 per year. Moreover, after external rotation or dorsiflexion injuries, syndesmotic disruption typically occurs at the ankle. The physiologic normality of the joint gets affected after a transverse syndesmotic screw fixation, which decreases the magnitude of motion at the lower extremes of the tibia and fibula, reducing contact forces between bones, and increasing stress on the crural interosseous membrane (which may lead to screw breakage). With this concern, we thus suggested to achieving a semi-rigid dynamic stabilization of the syndesmosis, using an endobutton and transosseous suture. We present a case of a 22-year-old active male who had a Lauge-Hansen pronation-abduction type injury. He was managed with an eight holes anatomical plate for lateral malleolus, two 65 mm CC screws with a washer for medial malleolus, and two endobuttons (one on the tibial and other on the fibular side) with transosseous sutures to provide stabilization of the syndesmosis. With this concern, we thus suggested achieving a semi-rigid dynamic stabilization of the syndesmosis, using an endobutton and transosseous suture; which can help in early mobilization, is cost effective, and prevent a second surgery for the removal of the syndesmotic screw.
Keywords: Endobutton, transosseous suture, suture anchor, syndesmotic injury, bimalleolar fractures
- Shibuya N, Davis ML, Jupiter DC. Epidemiology of foot and ankle fractures in the United States: An analysis of the National Trauma Data Bank (2007 to 2011). J Foot Ankle Surg 2014;53:606-8.
- Court-brown CM, Mcbirnie J, Wilson G. Adult ankle fractures: an increasing problem? Acta Orthop Scand 1998;69:43-7.
- Hsu RY, Lee Y, Hayda R, Digiovanni CW, Mor V, Bariteau JT. Morbidity and mortality associated with geriatric ankle fractures: A medicare Part A claims database analysis. J Bone Joint Surg Am 2015;97:1748-55.
- Jones MH, Amendola A. Syndesmosis sprains of the ankle: A systematic review. Clin Orthop Relat Res 2007;455:173-5.
- Parlamas G, Hannon CP, Murawski CD, Smyth NA, Ma Y, Kerkhoffs GM, et al. Treatment of chronic syndesmotic injury: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2013;21:1931-9.
- Cha SD, Kwak JY, Gwak HC, Ha DJ, Kim JY, Kim UC, et al. Arthroscopic assessment of intra-articular lesion after surgery for rotational ankle fracture. Clin Orthop Surg 2015;7:490-6.
- Schepers T, van der Linden H, van Lieshout EM, Niesten DD, van der Elst M, et al. Technical aspects of the syndesmotic screw and their effect on functional outcome following acute distal tibiofibular syndesmosis injury. Injury 2014;45:775-9.
- van den Bekerom MP, Hogervorst M, Bolhuis HW, van Dijk CN. Operative aspect of the syndesmotic screw: Review of current concepts. Injury 2008;39:491-8.
- Schepers T. To retain or remove the syndesmotic screw: Areview of literature. Arch Orthop Trauma Surg 2011;131:879-83.
- Passias BJ, Korpi FP, Chu AK, Myers DM, Grenier G, Galos DK, et al. Safety of early weight bearing following fixation of bimalleolar ankle fractures. Cureus. 2020;12:e7557.
- Seitz WH Jr., Bachner EJ, Abram LJ, Postak P, Polando G, Brooks DB, et al. Repair of the tibiofibular syndesmosis with a flexible implant. J Orthop . Trauma 1991;5:78-82.
- Thornes B, Shannon F, Guiney AM, Hession P, Masterson E. Suture-button syndesmosis fixation: Accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res 2005;431:207-12.
- Thornes B, Walsh A, Hislop M, Murray P, O’Brien M. Suture-endobutton fixation of ankle tibio-fibular diastasis: A cadaver study. Foot Ankle Int 2003;24:142-6.
- Yuen CP, Lui TH. Distal tibiofibular syndesmosis: Anatomy, biomechanics, injury and management. Open Orthop J 2017;11:670-7.
- Miller AN, Paul O, Boraiah S, Parker RJ, Helfet DL, Lorich DG. Functional outcomes after syndesmotic screw fixation and removal. J Orthop Trauma 2010;24:12-6.
- Moon YJ, Kim DH, Lee KB. Is it necessary to remove syndesmotic screw before weight-bearing ambulation? Medicine (Baltimore) 2020;99:e19436.
- Ræder BW, Stake IK, Madsen JE, Frihagen F, Jacobsen SB, Andersen MR, et al. Randomized trial comparing suture button with single 3.5 mm syndesmotic screw for ankle syndesmosis injury: Similar results at 2 years. Acta Orthop 2020;91:770-5.
|How to Cite this article: Koli VJ, Samant PD, Sane RM, Patil MJ, Singh PK. Effective and Sustainable Syndesmotic Injury Repair using Endobutton and Fiber wire, in Bimalleolar Fractures Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):135-138.|
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