Fixation of ankle syndesmotic injuries:​ comparison of TightRope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction

Naqvi, Gohar A.; Cunningham, Patricia; Lynch, Bernadette; Galvin, Rose; Awan, Nasir

Affiliations

¹Department of Trauma and Orthopaedics, Our Lady of Lourdes Hospital, Drogheda, Ireland

²Department of Radiology, Our Lady of Lourdes Hospital, Drogheda, Ireland

³HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland

Abstract and keywords

Background: Ankle syndesmotic injuries are complex and require anatomic reduction and fixation to restore the normal biomechanics of the ankle joint and prevent long-term complications.

Purpose: The aim of this study is to compare the accuracy and maintenance of syndesmotic reduction using TightRope versus syndesmotic screw fixation.

Study Design: Cohort study; Level of evidence, 2.

Methods: This cohort study included consecutive patients treated for ankle syndesmotic diastases between July 2007 and June 2009. Single slice axial computed tomography (CT) scans of both the ankles together were performed at the level of syndesmosis, 1 cm above the tibial plafond. A greater than 2-mm widening of syndesmosis compared with the untreated contralateral ankle was considered significant malreduction. Clinical outcomes were measured using the American Orthopaedics Foot and Ankle Society (AOFAS) and Foot and Ankle Disability Index (FADI) scores.

Results: Forty-six of 55 eligible patients participated in the study; 23 patients were in the TightRope group and 23 in the syndesmotic screw group. The average age was 42 years in the TightRope and 40 years in the syndesmotic screw group, and the mean follow-up time was 2.5 years (range, 1.5-3.5 years). The average width of normal syndesmosis was 4.03 ± 0.89 mm. In the TightRope group, the mean width of syndesmosis was 4.37 mm (SD, ±1.12 mm) (P = .30, t test) compared with 5.16 mm (SD, ±1.92 mm) in the syndesmotic screw group (P = .01, t test). Five of 23 ankles (21.7%) in the syndesmotic screw group had syndesmotic malreduction, whereas none of the TightRope group showed malreduction on CT scans (P = .04, Fisher exact test). Average time to full weightbearing was 8 weeks in the TightRope group and 9.1 weeks in the syndesmotic screw group. There was no significant difference between the TightRope and syndesmotic screw groups in mean postoperative AOFAS score (89.56 and 86.52, respectively) or FADI score (82.42 and 81.22, respectively). Regression analysis confirmed malreduction of syndesmosis as the only independent variable that affected the clinical outcome (regression coefficient, −12.39; t = −2.43; P = .02).

Conclusion: The results of this study indicate that fixation with TightRope provides a more accurate method of syndesmotic stabilization compared with screw fixation. Syndesmotic malreduction is the most important independent predictor of clinical outcomes; therefore, care should be taken to reduce the syndesmosis accurately.

Keywords: ankle syndesmosis; syndesmotic screw; TightRope; malreduction; Weber C fracture

Links

DOI: 10.1177/0363546512461480

PubMed: 23051785

WoS: 000311693700020

Cited Works (17)

Year	Entry
2004	Beumer A, van Hemert WLW, Niesing R, Entius CA, Ginai AZ, Mulder PGH, Swierstra BA. Radiographic measurement of the distal tibiofibular syndesmosis has limited use. Clin Orthop Relat Res. 2004;423:227-234.
2004	Høiness P, Strømsøe K. Tricortical versus quadricortical syndesmosis fixation in ankle fractures: a prospective, randomized study comparing two methods of syndesmosis fixation. J Orthop Trauma. July 2004;18(6):331-337.
2005	Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma. February 2005;19(2):102-108.
1998	Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures: an increasing problem? Acta Orthop Scand. February 1998;69(1):43-47.
1991	Seitz WH Jr, Bachner EJ, Abram LJ, Postak P, Polando G, Brooks DB, Greenwald AS. Repair of the tibiofibular syndesmosis with a flexible implant. J Orthop Trauma. March 1991;5(1):78-82.
1997	McBryde A, Chiasson B, Wilhelm A, Donovan F, Ray T, Bacilla P. Syndesmotic screw placement: a biomechanical analysis. Foot Ankle Int. May 1997;18(5):262-266.
2000	Thompson MC, Gesink DS. Biomechanical comparison of syndesmosis fixation with 3.5- and 4.5-millimeter stainless steel screws. Foot Ankle Int. September 2000;21(9):736-741.
2009	Coetzee JC, Ebeling PB. Treatment of syndesmoses disruptions: a prospective, randomized study comparing conventional screw fixation vs tightrope® fiber wire fixation – medium term results. S Afr Orthop J. Autumn 2009;8(1):32-37.
2006	Gardner MJ, Demetrakopoulos D, Briggs SM, Helfet DL, Lorich DG. Malreduction of the tibiofibular syndesmosis in ankle fractures. Foot Ankle Int. October 2006;27(10):788-792.
1997	Ebraheim NA, Lu J, Yang H, Mekhail AO, Yeasting RA. Radiographic and CT evaluation of tibiofibular syndesmotic diastasis: a cadaver study. Foot Ankle Int. November 1997;18(11):693-698.
2008	Dattani R, Patnaik S, Kantak A, Srikanth B, Selvan TP. Injuries to the tibiofibular syndesmosis. J Bone Joint Surg. April 2008;90B(4):405-410.
2012	Naqvi GA, Shafqat A, Awan N. Tightrope fixation of ankle syndesmosis injuries: clinical outcome, complications and technique modification. Injury. June 2012;43(6):838-842.
1976	Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg. April 1976;58A(3):356-357.
2001	van Staa TP, Dennison EM, Leufkens HGM, Cooper C. Epidemiology of fractures in England and Wales. Bone. January 2001;29(6):517-522.
2005	Thornes B, Shannon F, Guiney A-M, Hession P, Masterson E. Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res. February 2005;431:207-212.
2010	Wikerøy AKB, Høiness PR, Andreassen GS, Hellund JC, Madsen JE. No difference in functional and radiographic results 8.4 years after quadricortical compared with tricortical syndesmosis fixation in ankle fractures. J Orthop Trauma. January 2010;24(1):17-23.
2011	DeGroot H, Al-Omari AA, El Ghazaly SA. Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int. March 2011;32(2):250-256.

Cited By (3)

Year	Entry
2016	Lareau CR, Hsu AR, Cohen BE. Acute syndesmotic injuries. In: Valderrabano V, Easley M, eds. Foot and Ankle Sports Orthopaedics. Cham, Switzerland: Springer International Publishing; 2016:265-277.
2023	Doyle MD, Ligas CJ, Vora NS. Acute syndesmosis injuries. Clin Podiatr Med Surg. January 2023;40(1):23-37.
2013	Hunt KJ. Syndesmosis injuries. Curr Rev Musculoskel Med. December 2013;6(4):304-312.