A 3-D CT Analysis of Screw and Suture-Button Fixation of the Syndesmosis

Jason M. Schon, Brady T. Williams, Melanie B. Venderley, Grant J. Dornan, Jonathon D. Backus, Travis Lee Turnbull, Robert F. Laprade, Thomas O. Clanton

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Background: Historically, syndesmosis injuries have been repaired with screw fixation; however, some suggest that suture-button constructs may provide a more accurate anatomic and physiologic reduction. The purpose of this study was to compare changes in the volume of the syndesmotic space following screw or suture-button fixation using a preinjury and postoperative 3-D computed tomography (CT) model. The null hypothesis was that no difference would be observed among repair techniques. Methods: Twelve pairs of cadaveric specimens were dissected to identify the syndesmotic ligaments. Specimens were imaged with CT prior to the creation of a complete syndesmosis injury and were subsequently repaired using 1 of 3 randomly assigned techniques: (a) one 3.5-mm cortical screw, (b) 1 suture-button, and (c) 2 suture-buttons. Specimens were imaged postoperatively with CT. 3-D models of all scans and tibiofibular joint space volumes were calculated to assess restoration of the native syndesmosis. Analysis of variance and Tukey's method were used to compare least squares mean differences from the intact syndesmosis among repair techniques. Results: For each of the 3 fixation methods, the total postoperative syndesmosis volume was significantly decreased relative to the intact state. The total mean decreases in volume compared with the intact state for the 1-suture-button construct, 2-suture-button construct, and syndesmotic screw were -'561 mm3 (95% CI, -'878 to -'244), -'964 mm3 (95% CI, -'1281 to -'647) and -'377 mm3 (95% CI, -'694 to -'60), respectively. Conclusion: All repairs notably reduced the volume of the syndesmosis beyond the intact state. Fixation with 1 suture-button was not significantly different from screw or 2-suture-button fixation; however, fixation with 2 suture-buttons resulted in significantly decreased volume compared with screw fixation. Clinical Relevance: The results of this study suggest that the 1-suture-button repair technique and the screw fixation repair technique were comparable for reduction of syndesmosis injuries, although both may overcompress the syndesmosis.

Original languageEnglish
Pages (from-to)208-214
Number of pages7
JournalFoot and Ankle International
Issue number2
StatePublished - Feb 1 2017


  • TightRope
  • ankle
  • biomechanical
  • cadaveric
  • flexible implant
  • instability
  • screw
  • surgical technique
  • suture-button
  • syndesmosis
  • tibiofibular


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