This Level-I randomized trial compared two ways to stabilize an acutely injured ankle syndesmosis. Ninety-seven patients received either a dynamic suture button (TightRope) or a single 4.5-mm quadricortical syndesmotic screw. Outcomes were tracked clinically and with bilateral CT for 2 years.
When you stabilize an acute syndesmosis injury, the device choice affects both reduction quality and function. This trial gives Level-I evidence that a dynamic suture button outperforms a single quadricortical screw on AOFAS, OMA, pain, and CT-measured reduction at 2 years.
The mental model: a rigid screw holds the fibula statically and tends to lose reduction after removal, while the dynamic construct lets the fibula self-center and resists diastasis over time. That is why malreduction was about 2.5 times more common and recurrent diastasis (7 vs 0) clustered in the screw group, often after screw removal.
A caveat for appraisal: the trial was unblinded, the AOFAS scale is unvalidated for ankle fractures, and the screw group had more posterior malleolar fractures at baseline. Subgroup and regression analyses still favored the suture button, but weight the evidence accordingly.
This Level-I randomized trial compared two ways to stabilize an acutely injured ankle syndesmosis. Ninety-seven patients received either a dynamic suture button (TightRope) or a single 4.5-mm quadricortical syndesmotic screw. Outcomes were tracked clinically and with bilateral CT for 2 years.
When you stabilize an acute syndesmosis injury, the device choice affects both reduction quality and function. This trial gives Level-I evidence that a dynamic suture button outperforms a single quadricortical screw on AOFAS, OMA, pain, and CT-measured reduction at 2 years.
The mental model: a rigid screw holds the fibula statically and tends to lose reduction after removal, while the dynamic construct lets the fibula self-center and resists diastasis over time. That is why malreduction was about 2.5 times more common and recurrent diastasis (7 vs 0) clustered in the screw group, often after screw removal.
A caveat for appraisal: the trial was unblinded, the AOFAS scale is unvalidated for ankle fractures, and the screw group had more posterior malleolar fractures at baseline. Subgroup and regression analyses still favored the suture button, but weight the evidence accordingly.