A case series comparing ankle motion during functional activities between syndesmotic screw or suture-button fixation methods for distal tibiofibular syndesmosis instability
Keywords:tibiofibular, syndesmosis, suture-button, screw, gait, stairs, motion capture
Distal tibiofibular syndesmosis injuries can be stabilized with syndesmotic screws or suture-buttons. The objective was to compare ankle motion during gait and a step-down task between patients that had syndesmotic screw or suture-button fixation and healthy adults. This case series included two participants who received a syndesmotic screw and two participants that received a suture-button to fixate the distal tibiofibular syndesmosis. Time from surgery was 2 to 5 years. Ankle angles were measured during gait and a step-down task using an optical motion capture system and force plates. Peak angles and angle waveforms were compared to healthy adults (gait n=56, step-down n=14) using descriptive statistics. There was decreased ankle plantarflexion during gait for one participant that had a syndesmotic screw and one participant that had a suture-button compared to healthy adults. During step-down, there was decreased ankle dorsiflexion in three participants (1 suture-button, 2 syndesmotic screw) and decreased ankle eversion for both participants that had syndesmotic screws. There was no clear pattern of which surgical technique resulted in improved ankle motion. Other factors likely played a role in limiting ankle motion such as injury severity. Future studies should further compare ankle motion during functional activities between these surgical techniques in larger samples.
Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures--an increasing problem? Acta Orthop Scand. 1998 Feb;69(1):43-7. doi: 10.3109/17453679809002355. PMID: 9523255.
Laflamme M, Belzile EL, Bédard L, van den Bekerom MP, Glazebrook M, Pelet S. A prospective randomized multicenter trial comparing clinical outcomes of patients treated surgically with a static or dynamic implant for acute ankle syndesmosis rupture. J Orthop Trauma. 2015 May;29(5):216-23. doi: 10.1097/bot.0000000000000245. PMID: 25390468.
Hogg-Cornejo V, Hunt KJ, Bartolomei J, Rullkoetter PJ, Myers C, Shelburne KB. Normal kinematics of the syndesmosis and ankle mortise during dynamic movements. Foot Ankle Ortho. 2020 Jul;5(3):2473011420933007. doi: 10.1177/2473011420933007. PMID: 32885138.
Wong MT. Four-dimensional computed tomography to determine normal syndesmotic motion and to compare motion after rigid and flexible fixation of syndesmotic injuries [dissertation]. Graduate Program in Biomedical Engineering, University of Calgary; 2020. Available from: https://prism.ucalgary.ca/handle/1880/114485.
Grassi A, Samuelsson K, D'Hooghe P, Romagnoli M, Mosca M, Zaffagnini S, Amendola A. Dynamic stabilization of syndesmosis injuries reduces complications and reoperations as compared with screw fixation: a meta-analysis of randomized controlled trials. Am J Sports Med. 2020 Mar;48(4):1000-13. doi: 10.1177/0363546519849909. PMID: 31070854.
McKenzie AC, Hesselholt KE, Larsen MS, Schmal H. A systematic review and meta-analysis on treatment of ankle fractures with syndesmotic rupture: suture-button fixation versus cortical screw fixation. J Foot Ankle Surg. 2019 Sep;58(5):946-53. doi: 10.1053/j.jfas.2018.12.006. PMID: 31331790.
Shimozono Y, Hurley ET, Myerson CL, Murawski CD, Kennedy JG. Suture button versus syndesmotic screw for syndesmosis injuries: a meta-analysis of randomized controlled trials. Am J Sports Med. 2019 Sep;47(11):2764-71. doi: 10.1177/0363546518804804. PMID: 30358577.
Collins TD, Ghoussayni SN, Ewins DJ, Kent JA. A six degrees-of-freedom marker set for gait analysis: repeatability and comparison with a modified Helen Hayes set. Gait Posture. 2009;30(2):173-80. doi: 10.1016/j.gaitpost.2009.04.004. PMID: 19427282.
Robbins SM, Morelli M, Martineau PA, St-Onge N, Boily M, Dimentberg R, et al. A comparison of muscle activation and knee mechanics during gait between patients with non-traumatic and post-traumatic knee osteoarthritis. Osteoarthritis Cartilage. 2019 Jul;27(7):1033-42. doi: 10.1016/j.joca.2019.02.798.
Hoch MC, Farwell KE, Gaven SL, Weinhandl JT. Weight-bearing dorsiflexion range of motion and landing biomechanics in individuals with chronic ankle instability. J Athl Train. 2015 Aug;50(8):833-9. doi: 10.4085/1062-6050-50.5.07.
Bennell KL, Talbot RC, Wajswelner H, Techovanich W, Kelly DH, Hall AJ. Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust J Physiother. 1998;44(3):175-80. doi: 10.1016/s0004-9514(14)60377-9.
Konor MM, Morton S, Eckerson JM, Grindstaff TL. Reliability of three measures of ankle dorsiflexion range of motion. Int J Sports Phys Ther. 2012 Jun;7(3):279-87. PMID: 22666642.
Meir R, Crowley-McHattan ZJ, Whitting JW, Coetzee S. Foot to shank ratio: does it influence ankle dorsiflexion range of motion in the knee-to-wall assessment technique? N Z J Sports Med. 2017 Dec;44(2):65-9. Available from: https://www.researchgate.net/publication/310234292_Poster_Does_shank_to_foot_length_ratio_influence_knee-to-wall_ankle_DROM_performance.
Hale SA, Hertel J. Reliability and sensitivity of the Foot and Ankle Disability Index in subjects with chronic ankle instability. J Athl Train. 2005 Mar;40(1):35-40. PMID: 15902322.
Wikstrom EA, Tillman MD, Chmielewski TL, Cauraugh JH, Naugle KE, Borsa PA. Self-assessed disability and functional performance in individuals with and without ankle instability: a case control study. J Orthop Sports Phys Ther. 2009 Jun;39(6):458-67. doi: 10.2519/jospt.2009.2989.
Doll J, Waizenegger S, Bruckner T, Schmidmaier G, Wolf SI, Fischer C. Differences in gait analysis and clinical outcome after TightRope® or screw fixation in acute syndesmosis rupture: study protocol for a prospective randomized pilot study. Trials. 2020 Jul 2;21(1):606. doi: 10.1186/s13063-020-04550-5.
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