Outcomes of Suture-Button Fixation for Treatment of Maisonneuve Injuries

Abstract

Category: Ankle; Trauma Introduction/Purpose: The purpose of this study was to evaluate the radiographic and functional outcomes of suture-button devices for treatment of Maisonneuve injuries, which present unique considerations due to the proximal one-third fibular fracture, through which the distal fibular segment can potentially shorten. Methods: Patients undergoing operative management of Maisonneuve injuries from 2014-2018 utilizing suture-button devices with 2 fellowship-trained foot and ankle orthopedic surgeons were included. Exclusion criteria included use of a transosseous syndesmotic screw, fixation of the proximal fibular fracture, or less than 12 months follow-up. Medial clear space, tibiofibular clear space, tibiofibular overlap, talocrural angle, and distal fibular congruency on the injured and non-injured ankles were measured. Patients also completed the Foot & Ankle Ability Measure (FAAM)-Activities of Daily Living (ADL) and -Sports subscales and Visual Analog Scale (VAS) for pain (n/100). Thirty-three patients were included. Results: Three (9.1%) patients experienced a postoperative complication, including 1 wound dehiscence and 2 requiring hardware removal. No significant differences were demonstrated in radiographic parameters measured between 6-week and final radiographs on the injured ankle, as well between final radiographs taken of the injured and uninjured ankles (Table 1). At mean follow-up of 34.7 (range, 12-58) months, patients had a mean FAAM-ADL of 91.1, FAAM-Sports of 81.7, and VAS pain of 14.3. Conclusion: This study demonstrates that isolated use of suture-button devices for syndesmotic fixation in Maisonneuve injury patterns is effective at maintaining fibular length and reduction of the syndesmosis, as well as achieving satisfactory patient outcomes.