Syndesmotic fixation with suture buttons may allow for early weight-bearing
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Key takeaways:
- Syndesmotic fixation with suture button technique may allow for early weight-bearing in rotational ankle fractures.
- The early weight-bearing group had improved dorsiflexion with no difference in complications.
Results presented at the Orthopaedic Trauma Association Annual Meeting showed syndesmotic fixation with the suture button technique may allow for early weight-bearing in patients with rotational ankle fractures.
“[These results] give physicians more freedom to allow their patients to weight-bear a little earlier [and] be a little bit more aggressive with their rehab. But, from a research standpoint, we need more people to do the study to see if it is reproducible,” Kyle Schweser, MD, associate professor in the department of orthopedics, a trauma surgeon and director of the foot and ankle division at the University of Missouri, told Healio.
Schweser and colleagues randomly assigned 39 patients with rotational ankle fractures who underwent syndesmosis fixation with a suture button technique to weight-bear at either 2 weeks postoperatively (n = 16) or 6 weeks postoperatively (n = 23).
“The 2-week group was placed into a controlled ankle movement (CAM) boot at 2 weeks and was allowed to start weight-bearing with transitioning out of the CAM boot at 6 weeks,” Schweser said. “The 6-week weight-bearing group was kept non-weight-bearing. They were placed into a CAM boot at 2 weeks, just like the early weight-bearing group, but they were only allowed ankle range of motion exercises. At 6 weeks, they started weight-bearing, [and] we transitioned them out at 10 weeks.”
Researchers compared immediate postoperative and 1-year CT scans of both ankles and considered maintenance of reduction at 1 year as the primary outcome. Researchers included pain scores, surgical experience, American Academy of Orthopaedic Surgeons Foot and Ankle questionnaire, range of motion and complications as secondary outcomes.
“When we looked at CT scan measurements at immediate postop and 1 year, there was no difference,” Schweser said. “All [patients] had acceptable reduction parameters, postoperative reduction, and that reduction was maintained at 1 year, whether they were allowed to weight-bear early or not.”
According to Schweser, the early weight-bearing group had an average dorsiflexion of approximately 14° compared with 7° in the delayed weight-bearing group. Schweser said the two groups had similar outcome scores at 1 year, as well as similar satisfaction and complication rates.
“We need further studies. We need more numbers, we need more patients to achieve power, we need more people to do this study to try to reproduce it to make sure it holds and we also need to look at different types of syndesmotic fixation,” Schweser said. “We need to look at just screws vs. suture button technique or if newer fixation techniques utilizing tricorticial fixation are just as good.”
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Khaleel M, et al. Paper 121. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 23-26, 2024; Montreal, Québec, Canada.
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