The two prevalent fixation methods in the treatment of syndesmosis injuries, the rigid screw fixation and flexible Endobutton fixation, are not without issues; thus, we have designed a novel bionic fixation method which combines the features of both rigid and flexible fixations. The aim of this study was to compare the biomechanical properties of the bionic fixation to the screw and Endobutton fixations.
Six normal fresh-frozen legs from amputation surgery were used. After initial tests of intact syndesmosis, screw, bionic and Endobutton fixations were performed sequentially for each specimen. Axial loading as well as rotation torque were applied, in five different ankle positions: neutral position, dorsiflexion, plantar flexion, varus, and valgus. The displacement of the syndesmosis and the tibial strain were analysed using a biomechanical testing system.
Whether receiving axial loading or rotation torque, in most situations (neutral position, dorsiflexion, varus, plantar flexion with low loading, valgus with high loading, internal and external rotation), the bionic group and Endobutton group had comparable displacements, and there was no significant difference among the intact, bionic, and Endobutton groups; whereas the displacements of the screw group were smaller than any of the other three groups. Results of the tibial strain were similar with that of the displacement.
The bionic fixation at least equals the performance of Endobutton fixation; it also allows more physiologic movement of the syndesmosis when compared to the screw fixation and may serve as a viable option for the fixation of the tibiofibular syndesmosis.
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This study was supported by the Medical Science Research Key Project of Hebei Province, China (ZL20140115). And we thank Xiaolin Zhang, professor of Hebei Medical University, for statistical help in the analysis.
The authors have no financial or other conflicts of interest to disclose.
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Wang, L., Wang, B., Xu, G. et al. Biomechanical comparison of bionic, screw and Endobutton fixation in the treatment of tibiofibular syndesmosis injuries. International Orthopaedics (SICOT) 40, 307–314 (2016). https://doi.org/10.1007/s00264-015-2920-6
- Ankle fracture
- Surgical fixation