Mohamed A. Imam - Department of Trauma and Orthopaedics, Faculty of Medicine, Suez Canal University, Egypt
James Holton - Royal Orthopaedic Hospital, Birmingham, UK
Abdel Hassan - Ashford and St Peters Hospital, Chertsey, UK
Ahmed Matthana - Department of Trauma and Orthopaedics, Faculty of Medicine, Suez Canal University, Egypt

  Background: The importance of the syndesmosis in ankle stability is well recognized. Numerous means of fixation have been described for syndesmotic injuries including the suture button technique. Significant cost limits the use the commercially available options. We, therefore, designed a cheap and readily available alternative construct. We aim to assess the results of using a novel suture-button construct in treatment of syndesmotic ankle injuries. Methods: Fifty-two patients (34 males and 18 females) fulfilled our inclusion/exclusion criteria. Five patients were lost to follow-up. The remaining 47 patients were successfully followed up for a minimum of 24 months. The pre and post-surgery American Orthopedic Foot and Ankle Society scores (AOFAS) together with reported complications and post-operative radiological analysis were assessed. In this innovative construct, we utilized polyester braided surgical sutures jointly with double mini two- holed plates, a No.2 polygalactin 910 suture, a 4 mm drill bit, together with a 15 cm long suture needle with slotted end. This technique was supported with the use of the image intensifier. Results: The AOFAS score improved significantly from a mean of 32.4 to 94.2 (P˂0.004). Radiologically, the medial clear space (MCS), tibio-fibular clear space (TFCS) (P=0.05) and tibio-fibular overlap (TFO) measurements showed a significant improvement postoperatively (P=0.02). Patients reported good satisfaction rates with a 96% success rate (95% CI: 94.0% to 99.3%). Conclusion: We have observed that this low cost suture button construct is a simple, safe and cost effective treatment option for acute syndesmotic injuries. Level of evidence: IV

Suture button, Ankle, Syndesmosis, Injury