Skip to main content

The effect of suture-button fixation on simulated syndesmotic malreduction: a cadaveric study.

Publication ,  Journal Article
Westermann, RW; Rungprai, C; Goetz, JE; Femino, J; Amendola, A; Phisitkul, P
Published in: J Bone Joint Surg Am
October 15, 2014

BACKGROUND: The accuracy of reduction of distal tibiofibular syndesmosis disruptions has been associated with the clinical outcome. Suture-button fixation of the syndesmosis is a dynamic alternative mode of fixation. We hypothesized that with deliberate clamp-induced malreduction, suture-button fixation of the syndesmosis would allow a more anatomic post-fixation position compared with screw fixation. METHODS: Forty-eight syndesmotic fixations were performed on twelve through-knee cadaveric specimens. The syndesmosis was destabilized and off-axis clamping was used to produce both anterior and posterior malreduction patterns. In twelve scenarios (six anterior and six posterior malreductions), syndesmotic screw fixation was used, followed by computed tomography. With tenacula holding the malreduction, the syndesmosis screws were exchanged for a suture-button construct and the specimens underwent a subsequent computed tomography scan. In the other twelve scenarios, the suture-button fixation was achieved first, followed by screw fixation. Standardized measurements of anterior-posterior and medial-lateral fibular displacement were performed by two observers blinded to the method of fixation. RESULTS: With anterior off-axis clamping, the mean sagittal malreduction was 2.7 ± 2.0 mm with screw fixation and 1.0 ± 1.0 mm with suture-button fixation (p = 0.02). With posterior off-axis clamping, the sagittal malreduction was 7.2 ± 2.3 mm with screw fixation and 0.5 ± 1.4 mm with suture-button fixation (p < 0.01). No differences were observed between fixation types in the coronal plane (p = 0.20 for anterior malreductions and p = 0.06 for posterior malreductions). CONCLUSIONS: With deliberate malreduction in a cadaver model, suture-button fixation of the syndesmosis results in less post-fixation displacement compared with screw fixation. The suture button's ability to allow for natural correction of deliberate malreduction was greatest with posterior off-axis clamping. CLINICAL RELEVANCE: Although the clinical relevance is unknown, dynamic syndesmotic fixation may mitigate clamp-induced malreduction.

Duke Scholars

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

October 15, 2014

Volume

96

Issue

20

Start / End Page

1732 / 1738

Location

United States

Related Subject Headings

  • Suture Anchors
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cadaver
  • Ankle Injuries
  • Adult
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Westermann, R. W., Rungprai, C., Goetz, J. E., Femino, J., Amendola, A., & Phisitkul, P. (2014). The effect of suture-button fixation on simulated syndesmotic malreduction: a cadaveric study. J Bone Joint Surg Am, 96(20), 1732–1738. https://doi.org/10.2106/JBJS.N.00198
Westermann, Robert W., Chamnanni Rungprai, Jessica E. Goetz, John Femino, Annunziato Amendola, and Phinit Phisitkul. “The effect of suture-button fixation on simulated syndesmotic malreduction: a cadaveric study.J Bone Joint Surg Am 96, no. 20 (October 15, 2014): 1732–38. https://doi.org/10.2106/JBJS.N.00198.
Westermann RW, Rungprai C, Goetz JE, Femino J, Amendola A, Phisitkul P. The effect of suture-button fixation on simulated syndesmotic malreduction: a cadaveric study. J Bone Joint Surg Am. 2014 Oct 15;96(20):1732–8.
Westermann, Robert W., et al. “The effect of suture-button fixation on simulated syndesmotic malreduction: a cadaveric study.J Bone Joint Surg Am, vol. 96, no. 20, Oct. 2014, pp. 1732–38. Pubmed, doi:10.2106/JBJS.N.00198.
Westermann RW, Rungprai C, Goetz JE, Femino J, Amendola A, Phisitkul P. The effect of suture-button fixation on simulated syndesmotic malreduction: a cadaveric study. J Bone Joint Surg Am. 2014 Oct 15;96(20):1732–1738.

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

October 15, 2014

Volume

96

Issue

20

Start / End Page

1732 / 1738

Location

United States

Related Subject Headings

  • Suture Anchors
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Female
  • Cadaver
  • Ankle Injuries
  • Adult
  • 3202 Clinical sciences