Clinical results of fixation of syndesmosis rupture using simultaneously syndesmotic screw and suture button in case of high fibular fracture (case clinical series)

Abstract

Introduction. Fractures of middle and upper part of the fibula combined with syndesmosis rupture is a subtype of malleolar fracture, characterized by technical difficulties in reposition and fixation, and often bad prognosis. Goal.The goal of our research was to make an analysis of the literature, related to the problem of fixation of syndesmosis rupture in conjunction with fractures of middle and upper part of the fibula, and to represent case series of such patients treated with our method - combined syndesmosis screw and suture-button.Materials and methods. A comprehensive literature search was conducted in the electronic databases PubMed, Embase, Google Scholar, The Cochrane Database of Systematic Reviews CyberLeninka. Also we treat 3 patients with our method – combined syndesmosis screw and suture-button, and analyse short-term, middle-term and long term results of such treatment strategy. Results. Analysis of literature revealed that isolated use of suture button in situation of fixation of syndesmosis rupture in conjunction with fractures of middle and upper part of the fibula, do not provide stabilization of fibula in cranio-caudal and saggital plane. In such cases combined syndesmosis screw and suture-button usage could be beneficial. In our small case series we get good to excelent results.Discussion. Until now there is no consensus regarding best treatment option for syndesmosis rupture in conjunction with fractures of middle and upper part of the fibula. This type of fracture is accompanied by multi-directional instability of the distal fibula. Isolated usage of syndesmosis screw and suture-button has a number of restrictions.Conclusion. Сombined syndesmosis screw and suture-button usage could improve the results of treatment in such category of patients, hasten rehabilitation, provide better functional result, and decrease risk of complications.

Keywords

• tibio-fibular syndesmosis
• distal tibio-fibular syndesmosis rupture
• trimalleolar fracture
• syndesmotic screw
• positional screw
• suture button
• incisura fibularis