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All-suture fixation of syndesmotic injuries: a case series

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

To retrospectively evaluate the clinical outcomes of patients treated for syndesmotic injuries with an all-suture construct technique and compare their patient reported outcome scores with historically published outcomes of syndesmotic injuries fixed with suspensory suture buttons.

Methods

This was a retrospective case series of patients treated at a Level 1 Trauma Center from May 1, 2018, to June 30, 2022. Ten patients aged 18 and older with unstable syndesmotic injuries treated with all-suture repair. Patients were excluded if they were treated with trans-osseous screws, had previous failed syndesmotic fixation, or suspensory suture button fixation. Patient-reported outcomes including Visual Analog Scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores, and complications were recorded.

Results

In the patients with 6 weeks or more of radiographic follow-up (N = 9), there was no evidence of nonunion, loss of fixation, hardware complication, or whitling of the fibula by the suture. At final follow-up average VAS pain scores were 1.5 out of 10 (range 0–4; SD 1.2), AOFAS ankle and hindfoot scores averaged 89.6 out of 100 (range 86–100; SD 6.1). The pain subscale of the AOFAS score averaged 37.5 out of 40 (range 35–40; SD 2.5). The functional subscale of the AOFAS score averaged 46 out of 50 (range 44–50; SD 3.0). Stiffness was reported in one patient at their follow-up visits, which resolved with continued physical therapy. There were no superficial or deep infections.

Conclusions

In conclusion, this case series presents the first clinical outcomes of an all-suture fixation technique for treatment of unstable syndesmotic ankle injuries. Our results suggest that the all-suture fixation technique results in similar patient reported outcomes when compared with historically reported patient reported outcomes of suspensory suture button fixation, and low rates of complication or hardware failure.

Level of Evidence 4.

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Funding

This study was not funded.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, The University of Chicago, 5758 S. Maryland Avenue, Dept. 4B, Chicago, IL, 60637, USA

    Hayden P. Baker, Andrew Straszewski & Mary-Kate Erdman

  2. The University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA

    Samuel Gerak

  3. Edward Via College of Osteopathic Medicine, Spartanburg, SC, 29303, USA

    Sean Muir & Tyler James Rizzieri

  4. Medical Group of the Carolinas, Spartanburg, SC, 29307, USA

    Daryl B. Dillman

Authors
  1. Hayden P. Baker
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  2. Samuel Gerak
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  3. Sean Muir
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  4. Tyler James Rizzieri
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  5. Andrew Straszewski
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  6. Mary-Kate Erdman
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  7. Daryl B. Dillman
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Correspondence to Hayden P. Baker.

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The authors declare that they have no conflicts of interest that could influence the results, interpretation, or presentation of the findings contained in this manuscript.

Ethical approval

This research was conducted in strict compliance with the ethical standards and guidelines set forth by the 1964 Helsinki Declaration as well as current United States laws. This study received ethical approval from the Institutional Review Board (IRB) of the University of Chicago under protocol number IRB23-0229.

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Baker, H.P., Gerak, S., Muir, S. et al. All-suture fixation of syndesmotic injuries: a case series. Eur J Orthop Surg Traumatol 34, 1279–1286 (2024). https://doi.org/10.1007/s00590-023-03797-3

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  • DOI: https://doi.org/10.1007/s00590-023-03797-3

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