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Strategies in Trauma and Limb Reconstruction
Published in: Strategies in Trauma and Limb Reconstruction 3/2012

Open Access 01-11-2012 | Review

Flexible stabilization of the distal tibiofibular syndesmosis: clinical and biomechanical considerations: a review of the literature

Authors: Annick den Daas, Wouter J. van Zuuren, Stéphane Pelet, Arthur van Noort, Michel P. J. van den Bekerom

Published in: Strategies in Trauma and Limb Reconstruction | Issue 3/2012

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Abstract

Syndesmotic rupture is present in 10 % of ankle fractures and must be recognized and treated to prevent late complications. The method of fixation is classically rigid fixation with one or two screws. Knowledge of the biomechanics of the syndesmosis has led to the development of new dynamic implants to restore physiologic motion during walking. One of these implants is the suture-button system. The purpose of this paper is to review the orthopaedic trauma literature, both biomechanical and clinical, to present the current state of knowledge on the suture-button fixation and to put emphasis on the advantages and disadvantages of this technique. Two investigators searched the databases of Pubmed/Medline, Cochrane Clinical Trial Register and Embase independently. The search interval was from January 1980 to March 2011. The search keys comprised terms to identify articles on biomechanical and clinical issues of flexible fixation of syndesmotic ruptures. Ninety-nine publications met the search criteria. After filtering using the exclusion criteria, 11 articles (five biomechanical and six clinical) were available for review. The biomechanical studies involved 90 cadaveric ankles. The suture-button demonstrated good resistance to axial and rotational loads (equivalent to screws) and resistance to failure. Physiologic motion of the syndesmosis was restored in all directions. The clinical studies (149 ankles) demonstrated good functional results using the AOFAS score, indicating faster rehabilitation with flexible fixation than with screws. There were few complications. Preliminary results from the current literature support the use of suture-button fixation for syndesmotic ruptures. This method seems secure and safe. As there is no strong evidence for its use, prospective randomized controlled trials to compare the suture-button to the screw fixation for ankle syndesmotic ruptures are required.
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Metadata
Title
Flexible stabilization of the distal tibiofibular syndesmosis: clinical and biomechanical considerations: a review of the literature
Authors
Annick den Daas
Wouter J. van Zuuren
Stéphane Pelet
Arthur van Noort
Michel P. J. van den Bekerom
Publication date
01-11-2012
Publisher
Springer Milan
Published in
Strategies in Trauma and Limb Reconstruction / Issue 3/2012
Print ISSN: 1828-8936
Electronic ISSN: 1828-8928
DOI
https://doi.org/10.1007/s11751-012-0147-2

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