Ankle


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Buttoning Up a Syndesmosis Injury

There's a fibrous band of tissue between the two lower leg bones called the syndesmosis. It holds the bones together giving the ankle stability while still allowing motion. It's a real challenge to repair the syndesmosis when it's torn during an ankle injury. This is a report about a new way to suture the two bones together.

Until now most surgeons have used a long screw through the two bones to hold them together during healing. There are many problems with this treatment method. Since the two bones are meant to move slightly, the screw often loosens or gets broken. When healing does take place, a second surgery is needed to remove the screw.

The new flexible fixation uses a suture-button to hold the bones together. This means a braided piece of plastic goes through both bones. It's held in place by a button on the outside of each bone. The plastic is nonabsorbable but doesn't have to be removed after healing takes place.

With this new suture-button method of repair, patients can put weight on the leg sooner. They get back to work sooner, too. Ankle motion and function is better in patients who have this operation compared to patients who have a metal screw to hold the bones together.

After comparing patients with suture-buttons to patients with a metal screw, the authors conclude the suture-button is safe and cost-effective. With faster rehab, the suture-button may become the treatment of choice for patients with a torn syndesmosis.

Brian Thornes, FRCSI, et al. Suture-Button Syndesmosis Fixation. In Clinical Orthoaedics and Related Research. February 2005. Vol. 431. Pp. 207-212.

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