Speaker discusses myths, truths of syndesmotic fixation
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KOLOA, Hawaii — When performing syndesmotic fixation, surgeons can achieve better reductions and outcomes using an open vs. closed technique, Daniel S. Horwitz, MD, noted.
“The truth is, most of us should be opening almost all of our syndesmotic disruptions unless it is a nondisplaced disruption,” Horwitz said in his presentation at Orthopedics Today Hawaii.
Horwitz also said a separate anterior incision made directly over the ankle joint is more effective for visualization when cleaning out the syndesmosis than cleaning out the syndesmosis from a lateral approach.
“The truth is, [with the lateral approach], you’re not looking right down in. You’re not looking at that ‘Mercedes’ sign at the superior lateral aspect of the talus, so you don’t know for sure that you’re anatomically reduced,” he said.
Although flexible suture buttons are more expensive, these work better if the syndesmosis is not reduced and allow for settling and correction with time, according to Horwitz.
“If you’re going to consider using [flexible suture buttons], you need to know how to use them,” Horwitz said. “They’re relatively simple. Everybody, I think, has probably seen them. You drill the hole, you put [the needle] through, you deploy [the suture button] and you pull it back.”
Finally, Horwitz noted that syndesmotic screws do not need to be removed, except for possibly in young, active patients if they have not regained enough dorsiflexion at 16 weeks postoperatively and they want to get back to active athletics.
“I’ve [removed syndesmotic screws] once in 25 years,” Horwitz said. “Ninety-nine percent of the time, [patients] either ‘windshield wiper’ or they break the screw and they say that something popped and it hurt for a day.”
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Horwitz DS. Syndesmotic controversies. Presented at: Orthopedics Today Hawaii; Jan. 8-12, 2023; Koloa, Hawaii.
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