Management of Syndesmotic Ankle Injuries: Results of a Survey of Pediatric Orthopaedic Society of North America Members

Abstract

Background: Although utilization of dynamic suture-button fixation for adult syndesmotic injuries has shown improved outcomes over static screw fixation, data in pediatric populations is limited. This study evaluated trends in management and identified factors influencing surgeon choice of implant for pediatric syndesmotic injuries. Methods: The Pediatric Orthopaedic Society of North America (POSNA) members were surveyed regarding syndesmotic injury implant preferences between October 2021 and May 2022. Respondents that opted out, treated ​15 years posttraining. Twenty-four percent (24/102) preferred screw versus 76% (78/102) preferring suture-button implants for syndesmotic injuries. Members >15 years posttraining were 4.7 times more likely to prefer screw implants compared to members 15 years posttraining 4.7 times more likely to prefer screw fixation to members <5 years posttraining. (3) Among 62 respondents who switched implant preference during their clinical practice, avoidance of secondary surgery and extrapolation from outcomes in adults were the two most cited reasons. (4) Among 40 respondents who did not switch implant preference, comfort with the procedure was the most cited reason. (5) Comparative studies of suture-button versus screw implants for treatment of pediatric and adolescent syndesmotic ankle injuries are needed to establish an evidence-based standard of care management. Level of Evidence: Level V: Expert Opinion

Keywords

• Ankle syndesmosis injuries
• Survey
• Suture-button implant
• Syndesmosis screw implant
• Pediatric orthopaedic trauma