Relieve Health Group

Relieve Health Group

Syndesmotic injuries, which involve damage to the connective tissue between the two bones of the lower leg, the tibia and fibula, are a common concern in the field of podiatry. These injuries can lead to instability and pain, and require careful treatment to ensure proper healing and restoration of function. Two common methods of treatment are screw fixation and suture-button constructs. The choice between these two methods is a topic of ongoing debate in the medical community, with some advocating for the potential benefits of suture-button constructs, which may allow for more natural movement during the healing process.

The study in question aimed to shed light on this debate by comparing the effectiveness of these two methods in controlling fibular motion after a syndesmotic injury. The fibula, one of the two bones involved in a syndesmotic injury, plays a crucial role in the stability and function of the ankle. Therefore, understanding how different treatments affect its movement is key to determining the best approach to treating these injuries.

The researchers used eleven fresh-frozen cadaver legs with intact tibia-fibula articulations for their study. They secured these legs to a custom fixture and applied a 6.5-Nm external rotation moment to the foot, simulating the forces that the leg might experience in real-world conditions. They then used fluoroscopy and a high-resolution motion capture system to record the fibular motion in response to this force under various conditions: intact, complete lateral injury, complete lateral and deltoid injury, repair with a tetracortical 4.0-mm screw, and repair with a suture button construct.

The results of the study showed that the suture-button construct allowed significantly more motion in the sagittal plane (front to back movement) than the syndesmotic screw. This suggests that the suture-button construct may not provide the same level of stability as the screw fixation method. Additionally, the study found that external rotation of the fibula was significantly increased in both injury conditions and was not restored to intact levels with either the screw or the suture-button construct.

These findings have important implications for the treatment of syndesmotic injuries. While the suture-button construct may offer some advantages, such as potentially allowing for more natural movement during the healing process, this study suggests that it may not provide the same level of control over fibular motion as screw fixation. This could potentially lead to less stable healing and poorer clinical outcomes.

However, it’s important to note that this study was conducted on cadaver legs, which may not perfectly replicate the conditions in a living patient. Additionally, the study only looked at one type of suture-button construct and one type of screw fixation method. Other types of constructs or fixation methods may produce different results.

In conclusion, this study provides valuable insights into the treatment of syndesmotic injuries, but further research is needed to fully understand the implications of these findings. As always, medical professionals should consider the specific circumstances of each patient when deciding on the best course of treatment.

To read the full journal article, head to

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