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Fewer implants fail with dynamic fixation vs screws for syndesmosis rupture
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Researchers from Canada and the Netherlands found pain and function scores were better and there was a low reoperation and complication rate when they used a dynamic suture button design for ankle syndesmosis rupture fixation, according to a study scheduled to be presented at the upcoming EFORT Congress in Istanbul.
“When you fix the syndesmosis with a dynamic system, you are more anatomic,” Stéphane Pelet, MD, PhD, of CHU de Québec-Pavillon Enfant Jésus, told Orthopaedics Today Europe. “With [tightrope], you will achieve earlier, better functional results with fewer complications.”
The investigators conducted a prospective, randomized study of 70 patients with acute syndesmotic ruptures who underwent fixation with either dynamic fixation using an endobutton device (Tightrope; Arthrex, Naples, Fla., USA) or static fixation with one 3.5-mm quadricortical screw. They recorded the Olerud-Molander and American Orthopaedic Foot and Ankle Society (AOFAS) scores in all the patients, comparing the groups at 3 months, 6 months and 12 months post-treatment.
Pelet and colleagues saw improved Olerud-Molander scores at all three follow-up time points. At 3 months, AOFAS scores were better than before treatment, but not at 6 months or 12 months in the endobutton device group, which also showed better plantar flexion and less implant failure than the screw group.
Among the other findings were four patients in the screw group who lost reduction and needed early revisions. Two patients in the endobutton device group developed a superficial infection.
“The knot of the Tightrope created skin irritation,” Pelet said, and surgeons removed the device.
Pelet said the study was limited because CT scans were not used to assess the quality of the reductions and follow-up did not extend to 1 year.
Image: Pelet S
“We cannot detect long-term complications with this study,” he said. “We do not know with a short-term follow-up if the Tightrope will fail later on.”
The next step in this investigation, which is one of the top studies to be presented at the EFORT Congress, is to explore why the endobutton device results were better.
“Is it because it is dynamic or is it because there is a better reduction with the tightrope?” Pelet said. “If the system is dynamic, it is more forgiving to the joint and can help it stay more dynamic.”
The researchers plan to test the Tightrope with early weightbearing. – by Renee Blisard Buddle
Reference:
Pelet S. Paper #13-3027. Scheduled to be presented June 8 at the EFORT Congress; June 5-8, 2013; Istanbul.
For more information:
Stéphane Pelet, MD, PhD, can be reached at 1401 18th St., Québec (Quebec) 1Z4 G1J Canada; email: stephane.pelet.ortho@gmail.com.
Disclosure: Pelet receives grants and research support from Arthrex.