A Novel Suture Button Construct for Acute Ankle Syndesmotic Injuries; A Prospective Clinical and Radiological Analysis.

Abstract

<br /> <strong><span style="font-size: xx-small;">Background: </span></strong><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The importance of the syndesmosis in ankle stability is well recognized. Numerous means of fixation have been described for syndesmotic injuries including the suture button technique. Significant cost limits the use the </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">commercially available options. We, therefore, designed a cheap and readily available alternative construct. We aim to assess the results of using a novel suture-button construct in treatment of syndesmotic ankle injuries. </span></span><br /> <span style="font-size: xx-small;"><strong>Methods: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">Fifty-two patients (34 males and 18 females) fulfilled our inclusion/exclusion criteria. Five patients were </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">lost to follow-up. The remaining 47 patients were successfully followed up for a minimum of 24 months. The pre and post-surgery American Orthopedic Foot and Ankle Society scores (AOFAS) together with reported complications and post-operative radiological analysis were assessed. In this innovative construct, we utilized polyester braided surgical sutures jointly with double mini two- holed plates, a No.2 polygalactin 910 suture, a 4 mm drill bit, together with a 15 cm </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">long suture needle with slotted end. This technique was supported with the use of the image intensifier. </span></span><br /> <span style="font-size: xx-small;"><strong>Results: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">The AOFAS score improved significantly from a mean of 32.4 to 94.2 (</span></span><em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">P˂0.004</span></span></em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">). Radiologically, the medial </span></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">clear space (MCS), tibio-fibular clear space (TFCS) (</span></span><em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">P=0.05</span></span></em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">) and tibio-fibular overlap (TFO) measurements showed a significant improvement postoperatively (</span></span><em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">P=0.02</span></span></em><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">). Patients reported good satisfaction rates with a 96% success rate (95% CI: 94.0% to 99.3%). </span></span><br /> <span style="font-size: xx-small;"><strong>Conclusion: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">We have observed that this low cost suture button construct is a simple, safe and cost effective treatment option for acute syndesmotic injuries. </span></span><br /> <span style="font-size: xx-small;"><strong>Level of evidence: </strong></span><span style="font-family: Arial,Arial; font-size: xx-small;"><span style="font-family: Arial,Arial; font-size: xx-small;">IV </span></span>