Jun-Sik Park; Sung-Jin Lee; Sae-Hyun Kang; Gab-Lae Kim

doi:10.14193/jkfas.2018.22.4.161

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Park, Lee, Kang, and Kim: Comparision between Syndesmotic Screw Fixation and Knotless Tightrope® Fixation on Ankle Fractures with Distal Tibiofibular Syndesmosis Injury

Original Article

J Korean Foot Ankle Soc 2018;22(4):161-165.

Published online: 19 January 2018

DOI: https://doi.org/10.14193/jkfas.2018.22.4.161

Comparision between Syndesmotic Screw Fixation and Knotless Tightrope^® Fixation on Ankle Fractures with Distal Tibiofibular Syndesmosis Injury

Jun-Sik Park, Sung-Jin Lee, Sae-Hyun Kang, Gab-Lae Kim

Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea

Corresponding Author: Gab-Lae Kim Department of Orthopaedic Surgery, Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul 05355, Korea Tel: 82-2-2224-2230, Fax: 82-2-489-4391, E-mail: kiga9@hanmail.net ORCID: https://orcid.org/0000-0002-0282-1721

Received 30 July 201821 September 2018 Accepted 9 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

A distal tibiofibular syndesmosis injury with an ankle fracture is usually fixed with syndesmotic screws. Knotless Tightrope^® has been used as an alternative procedure because of the fewer reported complications. Therefore, this study compared the two surgeries.

Materials and Methods:

Forty-two patients, who underwent syndesmotic screw fixation, and 34 patients, who underwent Knotless Tightrope^® fixation for distal tibiofibular syndesmosis injury from February 2014 to February 2016, were analyzed retrospectively. The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, range of motion of ankle at 1 year after surgery, tibiofibular clear space, and tibiofibular interval at preoperative, postoperative and 1 year after surgery were investigated.

Results:

The VAS score, AOFAS score and radiographs were similar in the two groups. Knotless Tightrope^® showed better results in complications and plantarflexion.

Conclusion:

Knotless Tightrope^® fixation is a useful treatment that does not show a difference in fixation strength and clinical outcome. Knotless Tightrope^® fixation also has an advantage in the range of motion and complications.

Keywords: Ankle fracture, Syndesmotic injuries, Bone screws, Suture anchors

REFERENCES

1.Lin CF., Gross ML., Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther. 2006. 36:372–84.

2.Snedden MH., Shea JP. Diastasis with low distal fibula fractures: an anatomic rationale. Clin Orthop Relat Res. 2001. 382:197–205.

3.Ogilvie-Harris DJ., Reed SC., Hedman TP. Disruption of the ankle syndesmosis: biomechanical study of the ligamentous restraints. Arthroscopy. 1994. 10:558–60.

4.Sman AD., Hiller CE., Refshauge KM. Diagnostic accuracy of clinical tests for diagnosis of ankle syndesmosis injury: a systematic review. Br J Sports Med. 2013. 47:620–8.

5.Porter DA. Evaluation and treatment of ankle syndesmosis injuries. Instr Course Lect. 2009. 58:575–81.

6.Plessis GN., Griesel LD., Lourens D., Gräbe RP. Incidence of syndesmotic injuries in all different types of ankle fractures. SA Or-thop J. 2008. 7:28–32.

7.Park JC., McLaurin TM. Acute syndesmosis injuries associated with ankle fractures: current perspectives in management. Bull NYU Hosp Jt Dis. 2009. 67:39–44.

8.van den Bekerom MP., Kloen P., Luitse JS., Raaymakers EL. Complications of distal tibiofibular syndesmotic screw stabilization: analysis of 236 patients. J Foot Ankle Surg. 2013. 52:456–9.

9.Naqvi GA., Cunningham P., Lynch B., Galvin R., Awan N. Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction. Am J Sports Med. 2012. 40:2828–35.

10.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.

11.Coetzee JC., Ebeling P. Treatment of syndesmoses disruptions: a prospective, randomized study comparing conventional screw fixation vs TightRope^® fiber wire fixation: medium term results. SA Orthop J. 2009. 8:32–7.

12.Storey P., Gadd RJ., Blundell C., Davies MB. Complications of suture button ankle syndesmosis stabilization with modifications of surgical technique. Foot Ankle Int. 2012. 33:717–21.

13.Hong CC., Lee WT., Tan KJ. Osteomyelitis after TightRope(®) fixation of the ankle syndesmosis: a case report and review of the literature. J Foot Ankle Surg. 2015. 54:130–4.

14.Willmott HJ., Singh B., David LA. Outcome and complications of treatment of ankle diastasis with tightrope fixation. Injury. 2009. 40:1204–6.

Figure 1.

Examples of surgery using syndesmotic screw fixation. Preoperative radiographs (A), postoperative radiographs (B), and 12 months after surgery (C).

Figure 2.

Examples of surgery using Knotless Tightrope^® fixation. Preoperative radiographs (A), postoperative radiographs (B), and 12 months after surgery (C).

Figure 3.

Example of broken screw after syndesmotic screw fixation.

Figure 4.

Example of bone erosion (arrow) after Knotless Tightrope^® fixation.

Table 1.

Demographics Data of the Study

	Syndesmotic screw fixation	Knotless Tightrope^® fixation	p-value
Age (yr)	39.9 (20∼67)	38.2 (20∼69)	0.683
Sex			0.952
Male	25	20
Female	17	14
Follow-up period (mo)	18.3 (12~28)	17.8 (12~26)	0.659
Weber classification			0.679
A	1	0
B	26	21
C	15	13
Lauge-Hansen classifica	tion		0.626
SER	24	21
SA	1	0
PER	15	13
PA	2	0

Values are presented as mean (range) or number only. SER: supination external rotation, SA: supination adduction, PER pronation external rotation, PA: pronation abduction.

Table 2.

Clinical Findings between Syndesmotic Screw Fixation and Knotless Tightrope^® Fixation

	Syndesmotic screw fixation	Knotless Tightrope^® fixation	p-value
VAS score	1.5 (0~4)	1.2 (0~4)	0.202
AOFAS score	88.9 (72~97)	91.1 (78~97)	0.146
Dorsiflexion (。)	13.0 (0~20)	13.5 (0~20)	0.711
Plantarflexion (。)	30.9 (15~45)	35.6 (20~45)	0.043

Values are presented as mean (range).

VAS: visual analogue scale, AOFAS: American Orthopaedic Foot and Ankle Society.

Table 3.

Radiographic Difference between Syndesmotic Screw Fixation and Knotless Tightrope^® Fixation

	Syndesmotic screw fixation	Knotless Tightrope^® fixation	p-value
Tibiofibular clear space (mm)
Preoperatively	8.48 (4∼15)	8.35 (6∼13)	0.818
12 months postoperatively	7.31 (1∼15)	6.24 (3∼12)	0.118
p-value	0.01	<0.01
Tibiofibular overlap (mm)
Preoperatively	4.02 (0∼8)	4.06 (0∼8)	0.956
12 months postoperatively	4.98 (0∼11)	5.12 (0∼10)	0.806
p-value	0.005	0.029

Values are presented as mean (range).

Table 4.

Complications between Syndesmotic Screw Fixation and Knotless Tightrope^® Fixation

	Syndesmotic screw fixation K	Knotless Tightrop fixation	pe^® p-value
Broken screw (n)	5	0	0.012
Bone erosion (n)	0	3	0.083
Infection (n)	5	4	0.985

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