Post on 12-Nov-2014
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SYNDESMOSIS INJURIES
Brian Thornes, MCh, FRCSI, MBADublin, Ireland
PROBLEM: SYNDESMOSIS SCREWS
2011: Schepers T, et al Complications of Syndesmosis Screw Removal
76 patients
N=7 (9%) wound infectionN=5 (7%) recurrent diastasisN=5 (7%) occult broken screw
TOTAL: 22% complication rate
2007: S. Hakkalamani, et al Syndesmotic Screw Removal in Weber ‘C’ fractures
42 patients
N=6 wound infection (14%) N=4 instability pain (10%) N=1 DVTN=1 occult broken screw
TOTAL: 26% complication rate
2007: Wahlquist M. Late Diastasis following Syndesmotic Screw Removal
21 patients
Average 2mm widening of tibio-fibular clear space
38% of patients symptomatic
2009. Hamid N, et al Outcome after fixation of ankle fractures with an injury to the syndesmosis. The effect of a syndesmosis screw
52 patients
27 intact screws (AOFAS score 83)15 elective removal (AOFAS score 86)10 broken screws (AOFAS score 92)
Average 30 (12-56) month follow-up
2012. Mendelsohn ES, et al. The Effect of Obesity on Early Failure after Operative Syndesmosis Injuries
Re-operations for displacement:
15 in 102 (15%) obese patients vs.
2 in 111 (2%) non-obese patients
Obese: 12 times more likely to displace
2003: Thornes B, Walsh A, Hislop M, Murray P, O’Brien M Suture-Endobutton Fixation of Ankle Tibio-Fibular Diastasis: A Cadaver Study
2005: Thornes B, Shannon F, Guiney AM, Masterson ESuture-Button Syndesmosis Fixation. Accelerated Rehabilitation and Improved Outcomes
2006: Thornes B, McCartan DAnkle Syndesmosis Injuries Treated with the TightRope Suture-Button Kit
2009: Cottom JMComparison of suture-button to traditional screw fixation in 50 cases
25 Tightrope vs 25 Screw cohorts
Similar ankle outcome scores
68% removal rate with screws 0% removal rate with TightRope
2009: Coetzee JCSyndesmoses disruptions: A prospective, randomized study of screw fixation vs TightRope®
12 TightRope vs 12 Screw cases
12 month AOFAS score: 85 (TightRope) 76 (Screw)
Better range of motion in TightRope group
2011: DeGroot H, et alOutcomes of Suture Button Repair of the Distal Tibiofibular Syndesmosis
24 TightRope cases
AOFAS score: 94 (71-100) at 18 months
6 cases: local irritation from suture knot elective removal without difficulty
DISCUSSION“In summary, we believe the suture button device represents a viable alternative to screw fixation for syndesmosis injuries.
Because of the ease of use of the device and the ability to allow full weight-bearing without concerns about implant breakage, we feel that suture-button fixation is superior to conventional metallic screws.”
2011: DeGroot H, et alOutcomes of Suture Button Repair of the Distal Tibiofibular Syndesmosis
2012: Naqvi GA, Shafqat A, Awan NTightrope fixation of ankle syndesmosis injuries: Clinical outcome, complications & technique modification
49 TightRope cases
AOFAS score 86 (78-93) at 6 months
3 cases of implant removal (irritation/infection)
Senior author recommends burying lateral suture tails sub-perisoteally
1. Mal-Reduction
2. Mid-Diaphysis Fibula Fractures
3. Osteoporosis & Diabetes
CURRENT DEBATE
52% incongruity of fibula within incisura on postop CT scan
2006: Gardner M, et alMalreduction of the Tibiofibular Syndesmosis in Ankle Fractures
2008. Ho JY et al. Mid-Diaphyseal Fibular Fractures with Syndesmotic Disruption: Should We Plate the Fibula?
Cadaver study, 8 paired samples
• Rotational stability• Load-to-failure • Stiffness
Better with additional fibular plating vs. syndesmosis (screw) fixation alone
Therefore: if you can, FIX THE FIBULA
2010. Craik JD, et al. The Financial Impact of disatasis screw versus TightRope fixation of unstable syndesmosis injuries of the ankle
2 year audit of 79 cases
Ave. 5.9 follow-up OPD appointments (Screw)
Ave. 4.0 follow-up OPD appointments (TightRope)
TightRope saves:
34 theatre slots per annum
68 OPD appointments
£12,138 annual saving (60% of staff nurse salary in UK)
THANK YOU
www.ankletightrope.com