Clinical and radiological outcomes of screw fixation and suture-button technique in syndesmosis injuries with isolated lateral malleolus fractures.

BACKGROUND

Surgical stabilization is crucial for managing syndesmosis injuries following ankle trauma. While syndesmosis screws provide anatomical stability, they are associated with issues such as potential loosening or the need for removal. Screw breakage, although frequently reported, may not represent a true complication in asymptomatic patients. The suture-button technique aims to preserve physiological mobility and enhance functional outcomes.

PURPOSE: To compare the clinical and radiological outcomes of screw fixation and suture-button fixation in syndesmosis injuries with isolated lateral malleolus fractures.

STUDY

DESIGN

Retrospective comparative study.

METHODS

This study included 73 patients treated between 2018 and 2022. Patients were divided into two groups: suture-button fixation (n = 41) and syndesmosis screw fixation (n = 32). Clinical outcomes were assessed using AOFAS and OMAS scores, while MCS, TFCS, and TFO were used for radiological evaluation. The MCID was applied to determine the clinical relevance of score differences.

RESULTS

Both groups showed significant improvements in AOFAS and OMAS scores (p < 0.05). At final follow-up, the suture-button group demonstrated significantly higher AOFAS (95.9 ± 6.1 vs. 89.4 ± 12.6, p = 0.005) and OMAS (94.2 ± 8.1 vs. 88.9 ± 11.7, p = 0.025) scores, exceeding MCID thresholds. Although complication rates were lower in the suture-button group (p = 0.022), this difference became insignificant after excluding screw breakage (p = 0.951). Range of motion was also significantly better in the suture-button group (p = 0.033).

CONCLUSION

The suture-button technique provided superior clinical outcomes and joint mobility, while both methods offered comparable radiographic stability.